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Property  of  the 

Lancaster  City  and  County 
Medical  Society 


No. 


N-Vt-* 


-  ,<•/ 


THE 


AMERICAN      JOURNAL 


or  THE 


MEDICAL    SCIENCES. 


EDITED     BY 

ISAAC    HAYS,    M.D., 

SURGEON  TO  WILLS  HOSPITAL, 

PHYSICIAN  TO  THE  PHILADELPHIA  ORPHAN  ASYLUM,  &C.  &C. 


NEW    SERIES 

VOL.  IV. 


PHILADELPHIA; 
LEA     &     B  L  A  N  C  H  A  R  D 

LONDON: 
WILEY     &     PUTNAM: 

1S42. 


69431 


Entered  according  to  Act  of  Congress,  in  the  year  1842,  by 

LEA  &  BLANCHARD, 

In  the  office  of  the  Clerk  of  the  District  Court  for  the  Eastern  District  of 

Pennsylvania. 


T.  K.  &  P.  G.  COLLINS,  PRINTERS. 


TO  SENDERS  AND  CORRESPONDENTS. 


Communications  have  been  received  from  Drs.  Gibson,  Earle,  Arnold,  Met- 
tauer,  Nott  and  Henkel. 

Dr.  Taylor's  article  vi^as  crowded  out  of  the  present  number. 

The  following  works  have  been  received: — 

Traite  Pratique  sur  les  Maladies  des  oiganes  Genito-urinaires,  par  le  Docteur 
Civiale.  Deuxieme  partie  Maladies  du  col  de  la  vessie  et  de  la  prostate;  avec 
cinq  planches.  Paris,  1841.  Troisieme  et  derniere  partie  Maladies  du  corps 
de  la  vessie.     Paris,  1842.     (From  the  Author.) 

The  Pharmacopoeia  of  the  United  States  of  America.  By  Authority  of  the 
National  Medical  Convention,  held  at  Washington,  A.  D.  1841.  (From  the 
Committee  of  Publication.) 

A  memoir  on  the  Fossil  Reptiles  of  the  Southeast  of  England.  By  G.  A. 
Mantell,  Esq.,  LL.  D.,  F.  R.  S.,  &c.     London,  1841:  4to.    (From  the  Author.) 

A  Popular  Treatise  on  Vegetable  Physiology.  Published  under  the  auspices 
of  the  Society  for  the  Promotion  of  Popular  Instruction.  With  numerous  cuts. 
Philadelphia:  Lea  &  Blanchard,  1842.     (From  the  Publishers.) 

Twenty-fifth  Annual  Report  of  the  Asylum  for  the  Relief  of  Persons  Deprived 
of  their  Reason.     Philadelphia,  1842.     (From  Dr.  Warrington  and  Dr.  Earl.) 

Quarterly  Summary  of  the  Transactions  of  the  College  of  Physicians  of  Phi- 
ladelphia.    February,  March  and  April,  1842. 

Fifty-fifth  Annual  Report  of  the  Regents  of  the  University  of  the  State  of 
New  York.  Made  to  the  Legislature,  March  1,  1842.  Albany,  1842.  (From 
the  Regents.)  "" 

The  London  Dissector,  or  Guide  to  Anatomy,  for  the  Use  of  Students,  com- 
prising a  description  of  the  Muscles,  Vessels,  Nerves,  Lymphatics,  and  Viscera 
of  the  human  body,  as  they  appear  in  Dissection;  with  directions  for  their  De- 
monstration. From  the  first  American  Edition.  Revised  and  corrected  by 
Edw.  J.  Christy,  M.  D.,  Demonstrator  of  Anatomy  in  the  Univ.  of  Maryland. 
Baltimore,  1839. 

Lectures  on  the  Diagnosis,  Pathology  and  Treatment  of  the  Diseases  of  the 
Chest.  By  W.  VV.  Gerhard,  M.  D.,  Lecturer  on  Clinical  Medicine  to  the 
Univ.  of  Penn.,  &c.  Philadelphia:  Haswell  &  Barrington,  1842.  (From  the 
Publishers.) 

An  Historical  Sketch  of  the  State  of  American  Medicine  before  the  Revolu- 
tion; being  the  annual  address  delivered  before  the  Medical  Society  of  the  Slate 
of  New  York,  Feb.  1,  1842.  By  John  B.  Beck,  M.  D.,  President  of  the  Soci- 
ety, &c.  &c.  &o.     Albany,  1842.     (From  the  Author.) 

Observations  on  some  of  the  signs  of  live  and  still  birth,  in  their  applications 
to  Medical  Jurisprudence.  By  John  B.  Beck,  M.  D.,  Prof,  of  Mat.  Med.  and  Med. 
Jurisprudence  in  College  of  Phys.  and  Surg.,  New  York.     (From  the  Author.) 

Report  of  the  Trustees  of  the  New  York  State  Lunatic  Asylum,  with  the 


4  TO  READERS  AND  CORRESPONDENTS. 

documents  accompanying  the  same,  pursuant  to  the  act  of  the  Legislature, 
passed  May  26th,  1841.  Albany:  January,  1842.  (From  D.  Russell,  Chairman 
of  Board  of  Trustees.) 

Transactions  of  the  Medical  Society  of  the  State  of  New  York,  vol.  v,  pt.  ii. 
(From  the  Society.) 

Introductory  Lecture  delivered  in  the  Castleton  Medical  College,  March  8, 
1842.  By  James  McClintock,  M.  D.,  Prof,  of  Anatomy.  Castleton,  1842. 
(From  the  Author.) 

A  Circular  Letter  to  the  Physicians  of  Kentucky.     Maysville,  1842. 

Address  to  the  Graduates  of  the  Medical  Institution  of  Geneva  College.  De- 
livered 25th  January,  1842.  By  C.  B.  Coventry,  M.  D.,  Dean  of  the  Faculty, 
and  Prof,  of  Obstetrics  and  Medical  Jurisprudence.  Utica,  1842.  (From  the 
Author.) 

Annual  Catalogue  of  the  Medical  Institute  of  Louisville,  session  1841-42, 
and  the  circular  for  the  ensuing  session.  Louisville,  Ky.,  1842.  (From  the 
Librarian.) 

A.n  Address  to  the  Graduates  of  the  Medical  Department  of  the  Columbian 
College.  By  Thomas  Miller,  M.  D.,  Prof,  of  Anat.  and  Physiol.,  Dean  of  the 
Med.  Faculty.     Delivered  March  2,  1842.     (From  the  Author.) 

Circular  and  Catalogue  of  the  Officers,  Professors  and  Students  of  Willough- 
by  University,  at  Willoughby,  Lake  county,  Ohio.  Session  1841-2.  Cleave- 
land,  1842.     (From  the  Faculty.) 

Address  introductory  to  the  course  of  instruction  in  the  Anatomical  Rooms  of 
Geneva  Medical  College,  Nov.  2,  1841.  By  Sumner  Rhoades,  M.  D.,  Demon- 
strator of  Anatomy.     Geneva,  1841.     (From  the  Author.) 

Revue  Medicale  Francaise  et  etrangere.  Par  J.  B.  Cayol.  Nov.,  Dec.  1841. 
(In  exchange.) 

Journal  de  Medecine  et  de  Chirurgie  pratiques  a  I'usage  des  Medecins  prati- 
ciens.  Par  Lucas — Championniaire  D.  M.  P.  &c.  &c.  Dec.  1841,  Jan.  1842. 
(In  exchange.) 

Gazette  Medicale  de  Paris.  Oct.,  Nov.,  Dec.  1841,  Jan.  1842.  (In  exchange.) 

Journal  des  Connaissances  Medico-Chirurgicales.  Publie  par  MM.  A. 
Trousseau,  J.  Lebaudy,  H.  Gouraud.     Dec.  1841,  Jan.  1842.     (In  exchange.) 

Journal  des  Connaissances  Medicales  Pratiques  et  de  Pharmacologic,  Nov., 
Dec.  1841.     (In  exchange.) 

Journal  de  Pharmacie  et  des  Sciences  Accessoires.  Dec.  1841.  (In  ex- 
change.) 

Journal  de  Pharmacie  et  de  Chimie,  contenant  une  Revue  de  tons  les  travaux 
publiees  en  France  et  a  I'Etranger,  sur  les  Sciences  Physiques,  Naturelles, 
Medicales  et  industrielles  ainsi  que  le  Bulletin  des  Travaux  de  la  Societe  de 
Pharmacie  de  Paris.     Jan.  1842.     (In  exchange.) 

L'Examinateur  Medical.  Redacteurs  en  chef  MM.  Am.  Dechambre  et  Aug. 
Mercier.     Nov.,  Dec.  1841,  Jan.  1842.     (In  exchange.) 

London  and  Edinburgh  Monthly  Journal  of  Medical  Science.  Edited  by 
John  Rose  Cormack,  M.  D.     Feb.,  March,  April,  May,  1842.     (In  exchange.) 

Dublin  Medical  Press.   Jan.,  Feb.,  March,  April,  May,  1842.    (In  exchange.) 

Provincial  Medical  and  Surgical  Journal.  Edited  by  Dr.  Hennis  Green  and 
Dr.  Streeten.     Feb.,  March,  April,  May,  1842.     (In  exchange.) 


TO  READERS  AND  CORRESPONDENTS.  5 

Edinburgh  Medical  and  Surgical  Journal.     April,  1842.     (In  exchange.) 

Medico-Chirurgical  Review.  Edited  by  James  Johnson,  M.  D.,  and  Henry 
James  Johnson,  Lect,  on  Anat.     April,  1842.     (In  exchange.) 

British  and  Foreign  Medical  Review.  Edited  by  John  Forbes,  M.  D.,  &c. 
April,  1842.     (In  exchange.) 

London  Medical  Gazette.     Jan.,  Feb.,  March,  April,  1842.     (In  exchange.) 

The  Select  Medical  Library  and  Bulletin  of  Medical  Science.  Edited  by 
John  Bell,  M.  D.,  &c.  &c.     April,  1842.     (In  exchange.) 

Medical  Examiner.     April,  May  and  June,  1842.     (In  exchange.) 

The  New  York  Medical  Gazette.  April,  May  and  June,  1842.  (In 
exchange.) 

The  Boston  Medical  and  Surgical  Journal.  April,  May  and  June,  1842.  (In 
exchange.) 

The  American  Journal  of  Science  and  the  Arts.  Conducted  by  Prof.  Silliman 
and  Benj.  Silliman,  Jr.     April,  1842.     (In  exchange.) 

The  Western  Journal  of  Medicine  and  Surgery.  Edited  by  Drs.  Drake,  Yan- 
dell  and  Colescott.     March,  April,  1842.     (In  exchange.) 

The  New  York  Lancet.  Edited  by  J.  A.  Houston,  M.  D.  April,  May,  and 
June,  1842.     (In  exchange.) 

The  Western  and  Southern  Medical  Recorder.  Edited  by  J.  C.  Cross, M.  D., 
Prof,  of  Inst.  Med.  and  Med.  Jur.  in  Trans.  University.  April,  May  1842. 
(In  exchange.) 

The  American  Journal  of  Pharmacy.  Published  by  the  Philadelphia  College 
of  Pharmacy.  Edited  by  Jos.  Carson,  M.  D.,  and  Robert  Bridges,  M.  D. 
April,  1842.     (In  exchange.) 

The  New  England  Quarterly  Journal  of  Medicine  and  Surgery.  Edited  by 
C.  E.  Ware,  M.  D.,  and  Saml.  Parkman,  M.  D.     July,  1842.     (In  exchange.) 

The  Western  Lancet,  devoted  to  Medical  and  Surgical  Science.  Edited  by 
Leonidas  Moreau  Lawson,  M.  D.     May,  June,  1842.     (In  exchange.) 

The  American  Journal  and  Library  of  Dental  Science.  June,  1842.  (In 
exchange.) 

A  Practical  Treatise  on  Medical  Inhalation,  with  numerous  cases  demon- 
strating the  curative  powers  of  the  local  application  of  various  remedies  in 
Bronchitis,  Consumption,  and  other  Diseases  of  the  Respiratory  Organs;  em- 
bracing the  opinions  and  experience  of  Rush,  Sir  Charles  Scudamore,  Eberle, 
Mudge,  Crichton,  Thomas,  Corrigan,  Ramadge,  and  others.  By  Edward  Jen- 
nerCoxe,  M.D.     Philadelphia:  J.  Dobson,  1841.     (From  the  Publisher.) 

Ornithology:  The  Natural  History  of  Birds.  Third  Book  of  Natural  His- 
tory, prepared  for  the  use  of  Schools  and  Colleges.  By  W.  S.  W.  Ruschen- 
berger,  M.  D.,  Surgeon  U.  S.  N.,  &c.  &c.  From  the  text  of  Milne  Edwards 
and  Achille  Compte.  Philadelphia:  Turner  &  Fisher,  1842.  (From  the  Pub- 
lishers.) 


Communications  intended  for  publication,  and  Books  for  Review,  should  be 
sent,/ree  of  expense^  directed  to  Isaac  Hays,  M.  D.,  Editor  of  the  Amer.  Journ. 
of  Med.  Sci.,  care  of  Messrs.  Lea  &  Blanchard,  Philadelphia.  Parcels  directed 
as  above,  and  sent  (carriage  paid)  under  cover,  to  John  Miller,  Henrietta  Street, 

1* 


6  TO  READERS  AND  CORRESPONDENTS. 

Covent  Garden,  London,  or  to  Wiley  &  Putnam,  New  York,  or  W.  D.  Ticknor, 
Boston,  will  reach  us  safely.  We  particularly  request  the  attention  of  our 
foreign  correspondents  to  the  above,  as  we  are  often  subjected  to  unnecessary 
expense.  Some  time  since  we  received  from  New  York,  through  the  post 
office,  a  parcel,  bearing  the  seal  of  the  Royal  Society  of  Northern  Antiquaries, 
(Copenhagen,)  the  postage  of  which  was  twenty-six  dollars,  and  of  course  we 
were  compelled  to  refuse  it.  Had  it  been  sent  under  cover  to  Messrs.  Wiley  & 
Putnam,  the  expenses  would  have  been  but  a  trifle. 

All  remittances  of  money  and  letters  on  the  business  of  the  Journal,  should  be 
addressed  exclusively  to  the  publishers,  Messrs.  Lea  &  Blanchard. 


CONTENTS 


AMERICAN    JOURNAL 

OF  THE 

MEDICAL     SCIENCES. 

No.  V,  NEW  SERIES. 

JULY,  1842. 

ORIGINAL  COMMUNICATIONS. 

MEMOIRS  AND  CASES. 

ART.  PAGE. 

I.  Experiments  on  Kiesteine,  with  observations  on  its  application  to  the 
diagnosis  of  Pregnancy.     By  Elisha  K.  Kane,  M.  D.     -        -        -        -     13 

II.  Case  of  Complete  Anchylosis — in  which  the  Knee-joint  was  permanent- 
ly flexed — cured  by  an  operation.  By  Wm.  Gibson,  M.  D.,  Professor 
of  Surgery  in  the  University  of  Pennsylvania.  Reported  by  Thomas  L. 
Walker,  M.  D.,  of  Albemarle,  Virginia,  one  of  the  resident  Physicians 

of  the  Philadelphia  Hospital.     [With  two  wood  cuts.]  -         -         -     39 

III.  Practical  observations  on  those  Malformations  of  the  Male  Urethra 
and  Penis,  termed  Hypospadias  and  Epispadias,  with  an  Anomalous 
Case.  By  John  P.  Mettauer,  M.  D.,  of  Prince  Edward  county,  Virginia. 
[With  three  wood  cuts.] 43 

IV.  Cases  of  Disease  of  the  Brain  and  Spinal  Marrow.  By  James 
M'Naughton,  M.  D.,  Professor  of  Theory  and  Practice  of  Medicine  in 

the  Albany  Medical  College. .-        -57 

V.  Cases  of  Deformity  from  Burns,  relieved  by  Operation.  By  Thos. 
D.  Mutter,  M.  D.,  Professor  of  Surgery  in  Jefferson  Medical  College, 
Philad.,  &c.     [With  eight  wood  cuts,] 66 

VI.  Case  of  Gun-shot  Wound  of  the  Face,  with  loss  of  a  great  propor- 
tion of  the  Tongue,  and  extensive  lesion  of  the  bony  structure,  success- 
fully treated;  together  with  an  account  of  interesting  nervous  phenome- 
na, resulting  from  the  injury.     By  J.  F.  Peebles,  M.  D.,  Petersburg,  Va.     80 

VII.  Two  Cases  of  Inversion  of  the  Uterus.  By  W.  L.  Sutton,  M.  D.,  of 
Georgetown,  Ky. 83 

VIII.  Case  of  Extravasation  of  Blood  into  the  cellular  texture,  beneath  the 
skin  of  the  Penis.     By  Edward  Jarvis,  M.  D.,  Louisville,  Kentucky.    -    85 

MEDICAL  EDUCATION  AND  INSTITUTIONS. 

IX.  On  the  condition  of  the  Profession  on  the  eastern  coast  of  South  Ame- 
rica, and  the  prevalent  Diseases  of  that  country.     By  H.  Pleasants,  M. 

D.5  of  West  Philadelphia.     - 88 

REVIEWS. 

X.  Traite  des  Nevralgies,  au  affections  douloureuses  des  nerfs.  Par  F.  L. 
I.  Valleix,  Medecin  du  Bureau  Central  des  Hopitaux,  &c.  Paris,  1841, 
1  vol.  8vo.  pp.  719. 

A  Treatise  on  Neuralgia.  By  F.  L.  I.  Valleix,  Physician  to  the  "  Bureau 
Central"  of  the  Hospitals,  &c.     Paris,  1841,  pp.  719,  8vo.    -        -        -    95 


8  CONTENTS. 

XT.  The  Climate  of  the  United  States  and  its  Endemic  Influences.  Based 
chiefly  on  the  Records  of  the  Medical  Department  and  Adjutant-Gene- 
ral's Office,  United  States  Army.  By  Samuel  Forry,  M.  D.  New  York, 
1842:  8vo.  pp.  378. -  110 

XII.  A  System  of  Midwifery,  with  numerous  wood  cuts.  By  Edward 
Rigby,  M.  D.,  &c.,  with  Notes  and  additional  illustrations.  Philadel- 
phia, Lea^  Blanchard,  1841:  8vo.  pp.  491. 123 

BIBLIOGRAPHICAL  NOTICES. 

XTII.  Lectures  on  the  Diagnosis,  Pathology  and  Treatment  of  the  Dis- 
eases of  the  Chest.    By  W.  W.  Gerhard,  M.  D.,  Lecturer  on  Clinical 
Medicine  to  the  University  of  Pennsylvania,  &c.  &c.     Philadelphia: 
^  Haswell  &  Barrington,  1842,  8vo. ^135 

XIV.  1.  Second  Annual  Report  of  the  Directors  of  the  Marine  Insane  Hos- 
pital.    December,  1841.     Augusta,  Me.,  1841,  pp.  56. 

2.  Ninth  Annual  Report  of  the  Trustees  of  the  State  Lunatic  Hospital, 
at  Worcester,  (Mass.)     December,  1841.     Boston,  1842,  pp.  102. 

3.  State  of  the  New  York  Hospital  and  Blooraingdale  Asylum,  for  the 
year  1841.     New  York,  1842,  pp.  132. 

4.  Twenty-fifth  Annual  Report  on  the  State  of  the  "  Asylum  for  the  Re- 
lief of  Persons  deprived  of  the  use  of  their  Reason."  Philadelphia, 
1842,  pp.  30. 

5.  Third  Annual  Report  of  the  Directors  and  Superintendent  of  the 
Ohio  Lunatic  Asylum,  to  the  Fortieth  General  Assembly.  Columbus, 
(Ohio,)  1841,  pp.  60. 

6.  Annual  Report  of  the  Court  of  Directors  of  the  Western  Lunatic 
Asylum,  to  the  Legislature  of  Virginia;  with  the  Report  of  the  Phy- 
sician, for  1841.     Richmond,  Va.,  1842,  pp.  80. 

7.  Report  of  the  Superintendent  of  the  Eastern  Lunatic  Asylum,  Wil- 
liamsburg, Virginia,  from  July  1st,  1841,  to  December  31st,  1841. 

8.  Extracts  from  a  Lecture  on  Insanity;  delivered  before  the  Young 
Men's  Association  of  the  city  of  Utica.  February  18th,  1842.  By 
C.  B.  Coventry,  M.  D. 

9.  What  shall  we  do  with  the  Insane  of  the  Western  Country?  By 
Edward  Jarvis,  M.  D. 

10.  Fifth  Annual  Report  of  the  Trustees  of  the  Vermont  Asylum  for  the 
Insane.     October  25th,  1841. 

11.  Report  of  the  Trustees  of  the  State  Lunatic  Asylum,  with  the  docu- 
ments accompanying  the  same,  to  the  Legislature  of  the  State  of  New 
York,  pp.  203. 136 

XV.  The  Pharmacopoeia  of  the  United  States  of  America,  by  authority  of 
the  National  Medical  Convention  held  at  W^ashington,  A.  D.  1840:  8vo., 
Grigg  &  Elliott,  1842. 143 

XVI.  On  Regimen  and  Longevity;  comprising  Materia  Alimentaria,  Na- 
tional Dietetic  usages,  and  the  influence  of  Civilization  on  Health  and 
the  Duration  of  Life.  By  John  Bell,  M.  D.,  &c.  Philadelphia:  Has- 
well  &  Johnson,  1842,  12mo.  pp.  420. 145 

XVII.  Guide  du  medecin  practicien  ou  resume  general  de  pathologie  in- 
terne et  de  tlierapeutique  appliquees. 

The  Practitioner's  Guide;  a  Practical  Compendium  of  internal  Pathology 
and  Therapeutics.     By  F.  L.  I.  Valleix.     Paris,  1841,  Nos.  1  and  2.    -  147 

XVni.  Quarterly  Summary  of  the  Transactions  of  the  College  of  Physi- 
cians of  Philadelphia.     February,  March,  April,  1842,  8vo.  p.  24.  -148 

XIX.  Transactions  of  the  Medical  Society  of  the  State  of  New  York.   Vol. 

V,  Part  II. 149 

XX.  Annual  Report  of  the  Surgeon-General  of  the  United  States  Army.     -  150 

XXI.  On  the  Physical  Alterations  of  the  Blood  and  Animal  fluids  in  dis- 
ease.    By  M.  Andral. 151 


CONTENTS. 


SUMMARY 


IMPROVEMENTS    AND    DISCOVERIES 
MEDICAL    SCIENCES. 


IN    THE 


FOREIGN   INTELLIGENCE. 


Anatomy  and  Physiology. 


PAGE 

1.  Abstract  of  Mr.  Goodsir's  paper 
on  the  Ultimate  Secreting-  Struc- 
ture, and  on  the  laws  of  its 
Function.  -         .         -         -  155 

2.  Structure  of  the  Human  Kidney, 
and  the  changes  it  undergoes  in 
the  granular  degeneration.  By 
Mr.  Goodsir.     -        -        -        -  156 

3.  Arrangement  of  the  eighth  pair 

of  Nerves.     By  Mr.  Spence.      -  158 

4.  Singular   case  of  Monstrosity. 

By  Dr.  Rodenstab.    -        -        -  1581 


PAGE 

5.  Experiments  on  the  Saliva  ob- 
tained from  a  man  labouring 
under  fistula  of  the  right  parotid 
duct  near  its  extremity.  By 
Messrs.  Garrod  and  Marshall.    -  158 

6.  Observations  on  Parasitical 
grovi^ths  on  living  animals.  By 
Dr.  Busk,  Esq.  -         -         -  160 

7.  Dentition  of  Children  at  the 
Breast.  By  Professor  Trous- 
seau.        -----  164 


Materia  Medica  and  Pharmacy. 


8.  Styptic  effect  of  Kreasote.     By         |     By  M.  Meillet. 
Dr.  Burdach  of  Luckan.    -        -  166  10.  Lime    Moxa. 

9.  Sulpho-Cyanuret  of  Potassium.         I     borne. 


By    Dr. 


"  166 
Os- 
-  166 


Medical  Pathology,  Therapeutics,  and  Practical  Medicine. 


11.  Five  cases  of  Crowing  Inspi- 
ration of  Children  in  the  same 
family.  By  Jonathan  Toogood, 
Esq.  -         .         .         - 

12.  Case  of  enlarged  Thymus 
Gland,  producing  spasm  of  Glot- 
tis by  compressing  the  recurrent 
Nerves.  By  Thomas  Mitchell, 
M.  D.,  of  Dublin.      - 

13.  Identityof  Cow-pox  and  Small- 
pox. By  Dr.  Muhry,  of  Hano- 
ver. -         -         _         -         - 

14.  Vaccination  in  France  in  1840. 
By  M.  Gauthier  de  Claubry.      - 

15.  Sciatica  cured  by  Extract  of 
Belladonna.     By  M.  Hiriart.     - 

16.  On  the  incipient  stage  of  Can- 
cerous Affections  of  the  Womb. 
By  Dr.  W.  F.  Montgomery. 

17.  (Edema  of  the  Glottis.  By 
M.  Bricheteau.  -        -        . 

18.  Complete  obliteration  of  the 
Aorta.       By   Prof.   Roemer,   of 


-  167 


169 

I 
! 

169 
170 

170, 

1711 
172 


Vienna.    -        -        -        - 

19.  Typhoid  fever  in  the  Foetus. 
By  Dr.  Manzini.        -        -        _ 

20.  Tincture  of  Catechu  in  fissure 
of  the  Nipple. 

21.  Cases  of  unexpected  recovery 
from  large  Abscesses  in  the 
Lungs.     By  Dr.  Graves. 

22.  Sympathetic  Pruritus.  By 
Mr.  Walter  C.  Dendy. 

23.  Suffocating  Catarrh.  By  Mr. 
Robinson.  -         .         -         . 

24.  Cough  from  Spinal  Irritation. 

25.  Hiccup  from  Spinal  Irritation. 

26.  Asphyxia — the  relative  import- 
ance of  warmth  and  cold  to  the 
surface.     -         -         -         . 

27.  Extensive  Disease  of  the  Pan- 
creas. By  James  A.  Wilson, 
M.  D. 

28.  Influence  of  venereal  excesses 
in  the  production  of  Apoplexy. 

By  Dr.  Muynch.       -        -        -  179 


173 


173 


-  173 


-  174 

Y 

-  174 

176 
176 
176 


-  176 


178 


10 


CONTENTS. 


Surgical  Pathology  and  Therapeutics,  and  Operative  Surgery. 


page! 

29.  Treatment  of  Strangulated 
Hernia  by  Opium.  By  Drs. 
Bell,  Davis  and  Cooper.    -         -  179 

30.  Iodine  Injections  in  the  treat- 
ment of  Serous  Cysts.  By  M. 
Velpeau. 180 

31.  Permanent  closure  of  the  jaws 
cured  after  a  lapse  of  five  years 
by  division  of  the  masseter  mus- 
cle.    By  Prof.  Fergusson.  -  180 

32.  Formation  of  an  Artificial 
Anus  for  the  relief  of  Intestinal 
Obstruction.  By  Mr.  T.  P. 
Teale.    ^ 181 

33.  Artificial  Anus  in  lumbar  re- 
gion in  an  infant.  By  M. 
Amussat.  _         -         .         -  181 

34.  Rupture  of  the  Spine,  by  a  vio- 
lent muscular  effort.  By  M. 
Lasalle.    -         -         -         -         -  181 

35.  Wound  through  the  Sternum 
and  arch  of  the  Aorta.  By  Dr. 
Caspar. 182 

36.  Treatment  of  Ulcers  between         | 
the  Toes.     By  Dr.  Schlesier.     -  182 

37.  Successful       amputation       in         | 
spreading    Gangrene.      By    A. 

T.  S.  Dodd,  Esq.      -        -        -  182 

38.  Reunion  of  the  Fingers.  M. 
della  Fanteria.  -         .         -  184 

39.  Varicose  crural  vein.     By  Dr. 

de  Castella.       -        -         -         -  184 

40.  Semi-amputation  of  the  Ute- 
rus. By  Dr.  Grembler,  of  Neider 
Orschel. 184 

41.  Introduction  of  Air  into  the 
Veins.     By  Dr.  Godemer.  -  184 

42.  Necrosis  of  the  Os  Calcis.    By 

M.  Mallespine.  -        -        -  185 


PAGE 


43.  Hypertrophied  state  of  a  fold 
of  the  Schneiderian  membrane 
mistaken  for  nasal  polypus. 

44.  Van  Gesscher's  Bougies. 

45.  Ventral  Hernia.      .         -         - 

46.  Amputation  for  diseased  bone 
in  Children.     By  M.  Tayignot. 

47.  Spontaneous  Priapism  during 
thirty  hours,  with  retention  of 
Urine.     By  M.  Demeaux. 

48.  Berard's  mode  of  applying  the 
Vienna  caustic  for  the  cure  of 
varicose  veins.     By  M.  Berard. 

49.  Fracture  of  the  neck  of  the 
Femur.     By  Mr.  B.  Cooper. 

50.  Dislocation   of    the    Sternum 
By  M.  Maissoneuve. 

51.  Wounds  of  the  Femoral  vein  in 
operations  for  Aneurism.  By 
Mr.  Hadwen.    - 

52.  Polypi  of  the  Rectum  in  Chil- 
dren.    By  Prof.  Stolz.       - 

53.  Cases  of  double  Hare-lip — 
period  of  life  most  suitable  for 
operating  for  this  deformity.  By 
Mr.  Houston.    -         -         - 

54.  Amputation  during  Pregnancy. 
By  Mr.  Tarleton,  of  Birming- 
ham. -         _         -         -         - 

55.  Solution  of  Urinary  Calculi 
By  M.  Pelouse. 

56.  Cauterization  of  the  neck  of 
the  Uterus.     By  M.  Lisfranc.    - 

57.  Vesico-vaginal  Fistula.  By 
M.  Leroy  d'Etiolles. 

58.  Hernia  of  the  Stomach. 

59.  Rare  form  of  Internal  Strangu- 
I     lation.     By  Prof.  Geoghegan.   - 


185 
185 
185 

186 


186 


187 


-  187 


-  187 


-  187 


188 


-  188 


192 

-  193 

195 

195 
195 

196 


Ophthalmology. 


60.  On  certain  structures  in  the 
Orbit,  and  an  improved  method 
of  treating  its  Diseases.  By  J. 
M.  Ferrall,  Esq.        -         - 

61.  Rupture  of  the  Sclerotica  by  a 
blow  with  the  Fist.  - 

62.  Symblepharon.  By  M.  Petre- 
quin,  of  Lyons.  -         -         - 

63.  Turpentine  in  Scrofulous  Cor- 
neitis.     By  Mr.  Obre. 

64.  Irideremia.     By  M.  France.    - 

65.  Imperfect  development  of  the 
Eyes  with  Cataract.  By  Mr. 
Walker,  of  Manchester.     - 

66.  Cases  in  which,  after  the  fail- 


ure of  the  operation  for  Cataract 

on  one  eye,  the  vision  of  both 

eyes  was  restored,  by  operating 

197      on  the  cataract  on  the  opposite 

side.      By   M.   Serre,   Prof,   at 

-  201      Montpellier.      -         -         -        -  206 

67.  Melanosis  of   the   Eye.      By 

203      Dr.  Byron.        -        -        -        -  206 

i68.  Cysticerus   lodged    under  the 

205}     Conjunctiva.     By  Dr.   Hoering, 

205j     of  Luisburg.      -         -         -         -  211 

69.  Cataract  suddenly  formed    in 

boih   Eyes.     By  Dr.  Martin,  of 

205      Portlaw. 211 


CONTENTS. 


11 


Midwifery. 


PAGE 

70.  Extra-uterine  Pregnancy.     By 

M.  Blache.        -        -        -        -  211 

71.  Number  of  Pulsations  of  the 
Foetal  Chord.     By  Mr.  Streeter.  212 

72.  Rupture  of  the  Womb  during 
Gestation — Recovery.  By  Dr. 
Richter. 212 

73.  On  the  Management  of  the 
Placenta.     By  Mr.  Joseph  Bell.  212 

74.  Facts  relative  to  the  statistics 

of  Menstruation.       -        .        -  213 

75.  Extraordinary  Birth.  By  Dr. 
Schnackenberg.         -        -        -  213 


76.  Abstraction  of  the  Uterus  after 
delivery.     By  Dr.  Peracchi.      -  214 

77.  Polypusof  the  Uterus  expelled 
by  the  action  of  Secale  Cornu- 
tum.     By  M.  P.  Moyle.    -        -  214 

78.  Pregnancy  unattended  with  the 
usual  signs,  and  in  which  partu- 
rition occurred  without  labour- 
pains:  rupture  of  the  funis  which 
remained  untied  forty-five  mi- 
nutes. By  Thomas  Lewis,  Esq., 
Liverpool.         .        -        .        .  216 


Medical  Jurisprudence  and  Toxicology. 


79.  Guerard  on  the  consequences 
of  drinking  cold  liquids  when 
heated. 

80.  Detection  of  Arsenic  acid  by 
M.  Eisner.         -        -        -        _ 

81.  On  spots  in  glass  resembling 
those  of  Marsh,  produced  by  a 
reducing  flame.  By  Prof.  Lou- 
yet.  

82.  Do  Metallic  poisons  when 
mixed  with  cultivated  land,  enter 
into  the  composition  of  the  vege- 
tables produced?  By  MM.  Lou- 
yet  and  Verver.  _        .        _ 

83.  Superfo3tation.  By  Mr.  Re- 
nauldin.    

84.  Plea  of  Quick  with  Child  in 
criminal  cases.  By  Mr.  Grif- 
fiths, of  Wexham.      -        -        - 

85.  Presence  of  Lead  in  the  solids 
and  fluids.     By  Dr.  Budd. 

86.  On  a  new  mode  of  distinguish- 
ing arsenical  spots  from  antimo- 
nial  spots.     By  M.  Bischoff".     - 

87.  Nicotine.     By  M.  Barral. 

88.  Ergot.     By  Mr.  Quekett. 

89.  Suicide  from  Asphyxia  by 
choking,  from  the  introduction 
of  a  firm  plug  into  the  fauces. 
By  Dr.  Handyside,  of  Edin- 
burgh.      -        -        -        .        - 


190.  Minute  quantity  of  Opium  de- 

I  structive  to  the  life  of  a  child. 
217!     By  Mr.  Everest. 

91.  Signs  of  Pregnancy. — Kies- 
218      teine.     By  Mr.  Letheby.  - 

192.  New  Test  for  Nitric  Acid.       - 

93.  Are    medical    men    liable    to 
punishment    if    they   refuse    to 

218  make  a  medico-legal  dissection, 
or  a  chemical  analysis,  when 
called  upon  by  the  coroner?  By 
Dr.  Cambrelin,  of  Namur 

94.  Poisoning  with  flour  contain- 
219j     inglead.     By  Dr.  Schillbach.  -  225 

95.  On  the  varieties  observed  in 
2201     the  symptoms  of  poisoning  with 

I     Opium.     By  David  Skae.  -  225 

96.  Advanced  stage  of  the  Putre- 
220|     faction  of  the  Brain,  without  any 

I     corresponding  appearances  in  the 
221  i     rest  of  the  body.    By  M.  Millet.  226 
[97.  Birth  of  a  living  child  on  the 
1     179th  day.     By  Mr.  Tait.  -  227 

221  98.  Child  born  at  the  end  of  the 


223 

223 

224 


-  224 


222 

222 


222 


fifth  month,  which  lived  six 
days.  By  Dr.  John  Cochrane, 
of  Edinburgh.  -        -        -  227 

99.  Recovery  from  taking  two 
drachms  of  Arsenic.  Mr.  Too- 
good.         -        -        -        -        -  228 


Miscellaneous. 


100.  Animal  Magnetism.  By  Mr. 
Longmore.         -         -         -         -  228 

101.  Abstractof  a  paper  on  Opium 
smoking  in  China.  By  G.  H. 
Smith,  Esq.       -         -         -         _  229 

102.  The    Bavarian     Schools     of 


Medicine  suspended.  -         -  233 

103.  Desertion  of  children  in 
France.  By  MM.  Terme  and 
Monfalcon.        -         -         .         -  233 

104.  University  College,  London.    233 

105.  Obituary  Record.  -        -  233 


12 


CONTENTS. 


American  Intelligence. 


PAGE 

Expulsion  of  a  mass  of  hair  from 
the  Uterus.  By  Henry  R.  Frost, 
M.D.,  Charleston,  S.  C.  -  235 

Case  of  expulsion  of  the  Foetus 
about  the  sixth  month  with  the 
membranes  entire.  By  Robert 
S.  Bailey,  M.  D.,  Charleston, 
S.  C. 236 

Statistics  of  the  Medical  Colleges 
in  the  United  States.         -        -  237 

On  the  Intermittent  Fever  of  New 
England.  By  Samuel  Forry, 
M.D.        -        -        -        -        -  239 

Nathaniel  Chapman,  M.D.  -  240 

Observations  on  some  of  the  signs 
of  live  and  still-birth,  in  their 
applications  to  Medical  Juris- 
prudence By  John  B.  Beck, 
M.  D. 243 

Inversion  of  the  Uterus.  By  D. 
Humphreys  Storer,  M.  D.  -  247 

Operation  for  Artificial  Pupil  and 
subsequent  section  of  the  Rec- 
tus superior.  By  J.  Kearny 
Rodgers,  M.  D.         -        -        .  248 


PAGE 


Rupture  of  the  Uterus  from  exter- 
nal injury.     By  Dr.  F.  Hyde.    -  249 
Ligature    of    the    External    Iliac 

Artery.     By  Dr.  E.  Peace.        -  250 
Excision  of  a  large  Tumour  upon 
the  Neck.     By  R.  D.  Mussey, 

M.  D. 253 

Thymic    Enlargement.      By    Dr. 

W.  C.  Roberts.  -        -        -  254 

Blepharoplastic  operation  for  Ec- 
tropion.    By  Dr.  A.  C.  Post.    -  258 
Snake  Bites.     By  Prof.  Drake,  of 

Louisville.  -  -  -  -  258 
Medical  Schools  of  the  West.  -259 
Assistant  Surgeons  in  the  Navy.  -  259 
Medical  Advertising.  -  -  -  259 
Medical  College  of  Ohio.  -  -  259 
A  Popular  Treatise  on  Vegetable 

Physiology.  -  -  -  _  260 
Philadelphia  College  of  Pharmacy.  260 
University  of  Maryland.  -  -260 
Willoughby  Medical  School.  -  260 
Pennsylvania  Hospital.  -  -  260 
Yellow  Fever  at  Key  West.  -  260 
Obituary, 260 


THE 

AMERICAN     JOURNAL 


OF    THE 


MEDICAL    SCIENCES 


JULY,    1842. 


Article  L — Experiments  on  Kiesteine,  ivith  observations  on  its  ajyplica" 
Hon  to  the  diagnosis  of  Pregnancy.    By  Elisha  K.  Kane,  M.  D.* 

In  1831,  M.  Nauche  communicated  to  the  Society  of  Practical  Medicine 
of  Paris,  some  observations  on  a  gelatino-albuminous  product  found  in  the 
urine  of  pregnant  females  subsequent  to  the  first  month  of  gestation,  and 
which  is  separated  from  the  other  elements  of  that  fluid  by  rest  alone.  To 
this  product  he  gave  the  name  of  Kiesteine. 

If  the  urine,  he  says,  be  exposed  for  a  few  days  in  a  glass,  the  kiesteine 
shows  itself  at  the  surface,  in  the  form  of  specks  [points)  and  oblong  fila- 
ments, which  unite  in  a  pellicle  or  scum  of  a  line  in  thickness.  A  portion 
of  this  sinks  to  the  bottom  of  the  vessel,  and  forms  there  a  whitish  deposite 
of  a  milky  appearance;  the  rest  remains  on  the  surface,  adheres  to  the  sides 
of  the  glass,  and  is  converted  into  a  solid  membraniform  substance. 

The  pellicle  thus  formed,  he  regards  as  furnishing  a  certain  test  of  preg- 
nancy almost  from  its  commencement,  if  the  woman  is  in  health;  and  he 
asserts  that  he  has  frequently  determined  by  reference  to  it  the  existence  of 
that  condition,  when  it  would  not  otherwise  have  been  suspected.  He 
admits  that  in  diseases  in  which  there  is  a  secretion  of  pus,  in  dropsy,  in 
diabetes,  and  in  children  having  worms,  the  urine  is  often  covered  with 
an  albuminous,  fatty,  or  saline  scum,  resembling  somewhat  that  observed 
during  pregnancy;  but  he  affirms  that  after  a  litde  practice,  these  are  dis- 
tinguishable at  a  glance. 

M.  Nauche  was  followed  by  M.  Eguisier,  of  the  Sainte  Genevieve  Dis- 
pensary of  Paris,  who,  in  February,  1839,  published  an  article  in  the  Lan- 
cette  Frangaise,  in  which  he  described  the  pellicle  as  observed  by  himself. 

*  This  was  an  inaugural  dissertation  for  the  degree  of  Doctor  of  Medicine;  and  is 
published  in  pursuance  of  a  recommendation  of  the  Medical  Faculty  of  the  University 
of  Pennsylvania. 

No.  VII.— July,  1842.  2 


14  Kane  on  Kiesteine,  .  [July 

"From  the  second  to  the  sixth  day,"  he  says,  "small  opaque  bodies  are 
seen  rising  from  the  bottom  to  the  surface  of  the  liquid;  and  these  aggregat- 
ing by  degrees,  form  a  layer  which  covers  the  entire  surface:  this  is  the 
kiesteine.  It  has  sufficient  consistency  to  admit  of  being  lifted  up  with 
some  care  by  its  edges.  It  is  whitish,  opaline  and  somewhat  granulated, 
and  may  be  well  compared  to  the  fatty  scum  of  cool  broth."  He  considers 
it  an  invariable  attendant  of  pregnancy,  and  so  well  marked  in  its  distinctive 
characters  as  to  prevent  its  being  readily  confounded  with  others. 

M.  Eguisier  had  examined  twenty-five  cases.  Seventeen  of  these,  at 
periods  varying  from  the  fourth  to  the  ninth  month  of  utero-gestation,  were 
under  his  care  for  slight  indisposition:  four  had  been  pregnant  from  one  to 
four  months,  and  were  under  treatment  for  uterine  disease:  and  the  four 
others  were  affected,  respectively,  with  ascites,  sciatica,  ulceration  of  the 
neck,  and  a  supposed  uterine  disease,  for  which  repeated  cauterizations  had 
been  resorted  to.  In  all  of  these  the  characteristic  indications  of  kiesteine 
were  present;  and  in  the  four  last  mentioned,  the  existence  of  pregnancy 
was  ascertained  in  the  first  instance  by  reference  to  them  alone. 

In  the  following  year.  Dr.  Golding  Bird,  of  Guy's  Hospital,  published  in 
the  reports  of  that  institution  his  paper  "  on  the  existence  of  certain  ele- 
ments of  the  milk  in  the  urine  of  pregnant  women,"  founded  upon  the 
observation  of  "  about  thirty  cases."*  He  gave  succinctly  the  result  of  his 
examinations,  touched  on  the  microscopic  and  chemical  characters  of  the 
pellicle,  and  expressed  his  belief  that  it  is  an  imperfect  caseous  matter  mixed 
with  crystals  of  the  ammoniacal  phosphate  of  magnesia.  Pursuing  an  idea 
of  Professor  Burdach  of  Konigsburg,!  that  the  elements  of  the  milk  exist- 
ing in  the  circulation  may,  during  certain  conditions,  be  eliminated,  and  not 
finding  an  outlet  by  the  mammae,  be  again  taken  up  and  excreted  by  the 
kidneys,  he  supposes  such  elements  to  enter  into  the  constitution  of  the 
kiesteinic  pellicle. 

A  still  later  writer,  M.  Becquerel,:j:  in  his  "  Semeiotique  des  Urines,"  has 
noticed  the  observations  of  M.  Nauche,  but  without  admitting  the  truth  of 
his  conclusions.  He  had,  himself,  analysed  and  examined  the  urine  of  three 
pregnant  females,  and  had  occasionally  inspected  that  of  a  ^^  certain  number" 
in  different  stages  of  utero-gestation,  without  discovering  traces  of  the  kies- 
teine. 

I  believe  that  I  have  referred  in  this  brief  sketch  to  all  the  personal  obser- 
vations which  have  been  published  in  Europe  upon  this  subject.  They 
have  of  course  attracted  the  notice  of  the  journalists,§  and  some  of  the 

*  Guy's  Hospital  Reports,  No.  10,  April,  1840. 

t  Traile  de  Physiologie,  Paris,  1839. 

^  Semeiotique  des  Urines,  ch.  ix.,  Paris,  1841. 

§  Journal  de  Chimie  Medicale,  Fev.,  1839,  p.  64.  London  Lancet,  No.  417,  p.  675. 
Dublin  Journal,  vol.  VI.  Medico-Cliirurgical  Review,  1839,  p.  228.  Am.  Journ.  of  Med, 
Sci.,  Feb.  1840,  p.  483;  Ibid.  Aug.  1840,  p.  501.    Am.  Med.  Tntelligencer. 


1843.]  Kane  on  Kiesteine,  15 

more  elaborate  writers  of  the  profession  have  alluded  to  them  in  their  trea- 
tises.* 

Some  indeed  have  assigned  to  the  discovery  a  much  earlier  date,  referring 
it  to  Savonarola,  who,  as  far  back  as  1486,  detailed  minutely  a  series  of 
changes  incidental  to  the  urinary  excretion  from  the  commencement  of 
utero-gestation  to  the  seventh  month.  I  have  been  unable  to  obtain  a  copy 
of  this  venerable  author,  and  cannot,  therefore,  speak  personally  with  regard 
to  his  observations;  but  I  find  by  reference  to  Fodere,  and  others  who 
quote  his  opinions,  that  after  describing  the  colour  of  the  fluid,  he  mentions 
a  *'  cloud  upon  the  surface,"  adverting  at  the  same  time  to  a  deposite  par- 
tially suspended  resembling  carded  wool.  This  description  may  perhaps 
identify  this  superficial  cloud  with  the  pellicle  of  M.  Nauche.  If  so,  how- 
ever, the  question  of  originality  will  arise  between  Savonarola,  and  some  of 
the  still  more  ancient  writers  of  the  Moorish  and  Arabian  schools. 

The  urine,  it  is  well  known,  in  common  with  all  the  excrementitial  and 
secreted  fluids,  was  anciently  a  subject  of  habitual  though  vague  observa- 
tion. Yet,  if  we  except  the  increased  redness,  noticed  by  Hippocrates  and 
some  others,  as  pertaining  to  the  latter  months  of  gestation,  nothing  can  in 
any  case  be  gleaned  from  the  works  of  ancient  writers,  by  which  the  phases 
of  the  urine  may  be  applied  to  the  determination  of  pregnancy.  Thus, 
Galen,  Magnus  of  Antioch,  and  Pliny,  allude  in  a  general  and  obscure 
manner  to  the  urine  and  its  changes,  without  referring  to  the  peculiarities  it 
exhibits  during  pregnancy.  But  Avicenna  and  Rhazes  are  quoted  by  M. 
Eguisier,  as  describing  the  white  cloud,  the  central  deposite,  and  the  minute 
bodies  ascending  and  descending;  not  indeed  as  signs  absolutely  indicative 
of  pregnancy;  yet  as  generally  attending  it, — the  deposite  beimg  perhaps  the 
most  constant. 

It  may,  however,  be  conceded,  that  up  to  the  present  time,  the  existence 
and  character  of  these  appearances  have  not  been  the  subject  of  entirely  satis- 
factory investigation.  To  justify  general  conclusions,  a  larger  number  of  cases 
should  be  examined,  individually  and  in  group,  and  their  progress,  changes, 
and  points  of  difl"erence  noted.  They  should  be  viewed  under  diflferent 
aspects,  at  regular  and  frequently  recurring  intervals.  If  the  indications  of 
a  particular  case  should  appear  to  vary  from  those  of  others,  repeated  obser- 
vations would  become  necessary  to  detect  the  causes  of  variance;  and  the 
influence  of  similar  causes  upon  other  cases,  where  they  existed,  also  should 
then  be  sought  for.  And  I  may  be  excused  for  adding,  that  a  candid  spirit, 
not  too  much  biased  in  favour  of  theory  to  admit  the  existence  of  observed 
exceptions,  that  looks  to  each  clearly  ascertained  result  as  an  independent 
element,  and  rejects  nothing  that  appears  true  because  irreconcilable  with 
what  was  known  before,  is  not  less  important  to  the  formation  of  correct 
opinions,  than  the  most  careful  and  varied  scrutiny  of  facts. 

*  Montgomery,  Dunglison,  Churchill,  Rigby,  Traill,  &.c.  &c. 


16  Kane  on  Kiesteine.  [July 

It  is  not  meant  to  intimate  by  this,  that  the  gentlemen  who  have  treated 
on  this  subject  have  been  regardless  of  these  precautions,  or  wanting  in  the 
proper  spirit  of  inquiry;  but  it  is  apparent  that  their  observations  have  been 
rather  of  isolated  cases  than  of  classes,  that  they  have  not  compared  a  large 
number  of  results,  and  that  they  have  failed  to  detect  any  exceptions  to  their 
general  conclusions. 

M.  Eguisier  speaks  of  only  twenty-five  cases,  Dr.  Golding  Bird  of 
**  about  thirty,"  and  M.  Becquerel's  scrutiny,  with  immediate  reference  to 
this  question,  embraced  only  three.  So  that,  as  to  all  those  who  have  fol- 
lowed M.  Nauche  in  Europe,  it  may  be  said  with  truth,  that  the  aggregate 
of  their  observations  does  not  number  sixty  cases.  It  should  not,  therefore, 
surprise  us,  if  a  more  extended  investigation  were  to  lead  to  a  modification 
of  their  conclusions. 

In  the  spring  of  last  year,  while  one  of  the  resident  physicians  at  the  Phi- 
ladelphia Hospital,  I  availed  myself  of  the  facilities  which  were  liberally 
afforded  me  by  the  managers  of  that  institution,  to  commence  a  series  of 
observations  on  the  subject  of  kiesteine;  and  I  have  continued  them  to  the 
present  time.  The  number  of  patients  in  the  several  wards  was  such  as  to 
make  it  easy  to  classify  and  group  the  cases,  and  my  position  enabled  me  at 
all  times  to  scrutinize  the  circumstances  of  each,  much  more  fully  than  could 
have  been  done  in  private  practice. 

My  friends,  Drs.  McPheeters  and  Perry,  who  were  residents  with  me  at 
the  time  I  began,  had  already  made  some  interesting  observations  on  the 
subject  at  the  instance  of  Dr.  Dunglison,*  which  they  subsequently  published 
in  his  Medical  Intelligencer;  but  though  their  politeness  had  enabled  me  to 
watch  the  progress  of  their  investigations,  I  had  not  adopted  their  conclu- 
sions, and  was  in  fact  careful  to  avoid  the  influence  which  the  known  opi- 
nions of  others  might  have  had  upon  the  freedom  of  my  own. 

My  mode  of  conducting  the  experiments  was  this.  The  recent  urine  was 
placed  in  open  glass  cylinders,  of  diameters  varying  from  an  inch  and  a  half 
to  that  of  a  common  tumbler,  and  protected  from  dust  by  paper  covers. 
These  were  arranged  in  a  dry,  well  ventilated  room,  where  the  temperature 
was  uniform  and  moderate,  and  were  exposed  in  groups  to  the  equal  action 
of  air  and  light. f  I  examined  them  frequently  during  the  day;  but  as  the 
changes  were  not  rapid,  I  determined  after  a  little  while  to  note  only  one  set 

*  I  should  do  much  wrong  to  my  feelinors,  were  I  to  pass  the  name  of  this  gentleman 
without  acknowledging  the  obligations  I  am  under  to  his  unwearying  kindness.  No  one 
promotes  more  happily  a  spirit  of  inquiry  among  the  younger  members  of  the  profession, 
or  is  more  prompt  to  render  them  service. 

t  These  precautions  were  not  unimportant.  My  attempts  in  the  "  Green  Room  of  the 
Hospital"  were  unsuccessful,  in  consequence  of  the  dampness  producing  fungoid  modifi- 
cations  of  the  scum;  and  in  very  cold  or  very  hot  weather,  the  pellicle  formed  very  re- 
luctantly,  or  was  anticipated  by  the  decomposition  of  the  urine.  The  room  should  be 
sufficiently  lighted  to  admit  of  minute  examination,  and  the  specimen  should  be  kept 
absolutely  at  rest  during  the  progress  of  the  inquiry. 


1842.]  Kane  on  Kiesteine,  17 

of  observations  in  the  twenty-four  hours.  My  notes  were  always  made 
upon  the  spot.  If  from  any  cause,  an  individual  observation  or  a  series  was 
unsatisfactory,  or  inconclusive;  or  if  it  led  to  a  different  result  from  others,  I 
repeated  it  at  once  with  increased  care;  and  I  was  always  careful  to  observe 
the  constitution,  habits  and  circumstances  generally  of  each  patient. 

The  examination  of  the  first  group  of  cases  satisfied  me,  that  the  urine 
during  pregnancy  assumes  appearances  different  from  those  witnessed  under 
other  circumstances,  and  which  I  was  therefore  disposed  to  regard  as  cha- 
racteristic of  that  state.  Subsequent  inquiries  confirmed  me  in  the  general 
accuracy  of  this  opinion,  but  compelled  me  at  the  same  time  to  admit  its  lia- 
bility to  exception. 

The  more  obvious  of  these  appearances  regard  the  superficial  formation 
described  by  Dr.  Bird,  and  recently  investigated  by  Drs.  McPheeters  and 
Perry;  but  there  are  others  which  point  to  a  series  of  intestine  changes 
somewhat  more  obscure,  though  scarcely  less  interesting.  My  observations 
applied  to  both;  and  I  regret  that  the  limited  time  at  my  command  during 
the  studies  preliminary  to  graduation,  obliges  me  to  select  a  single  class  as 
the  subject  of  this  dissertation.  I  take,  however,  that  indication  which  seems 
to  me  best  fitted  for  practical  usefulness  in  diagnosis,  the  pellicular  change, 
and  which  I  suppose  to  be  most  properly  called  the  Kiesteine. 

The  urine,  submitted  to  observation  in  the  way  I  have  described,  presents 
but  little  change  during  the  first  thirty-six  hours.  The  mucous  flocculi,  if 
they  exist,  gradually  subside  during  this  period,  forming  a  whitish  cloud- 
like deposite  at  the  bottom  and  sometimes  on  the  sides  of  the  glass;  while 
more  or  less  alteration  occurs  in  the  colour  and  transparency  of  the  fluid. 

The  surface  remains  for  a  short  time  entirely  unchanged;  but  in  most 
cases,  a  greater  or  less  number  of  shining  acicular  specks,  apparently  crys- 
talline, begins  to  be  seen  within  the  first  eighteen  or  twenty-four  hours. 
These  are  generally  scattered  over  the  surface  without  regularity;  but  in 
some  rare  cases,  they  are  so  disposed  as  to  form  a  translucent  film  of  uni- 
form thickness,  which  afterwards  assumes  the  more  defined  characters  of  the 
pellicle.  How  far  these  crystals  are  essentially  connected  with  the  forma- 
tion of  the  pellicle,  X  am  not  prepared  to  say.  In  many  cases,  I  have  not 
succeeded  in  detecting  their  presence,  even  by  the  microscope;  and,  indeed, 
I  have  failed  to  discover  any  unvarying  indications  whatever  of  the  ap- 
proaching development  of  the  Kiesteine. 

The  cloudlike  appearance,  which  is  alluded  to  by  Nauche  and  Eguisier, 
although  possessed  of  much  interest,  I  have  not  found  to  be  a  uniform  premo- 
nitor  of  the  forming  pellicle;  I  have  supposed  it  to  be  nothing  more  than  the 
Enaeorema  of  the  older  writers,  depending  upon  the  imperfect  aggregation  of 
mucous  flocculi;  for  I  have  seen  it  repeatedly  when  there  was  no  pregnancy 
to  account  for  it,  and  it  was  uniformly  absent  where  the  fluid  presented  per- 
fect transparency. 

The  time  at  which  the  pellicle  begins  to  form  varies  considerably.     I  have 

2* 


18  Kane  on  Kiesteine.  [Jw^y 

seen  it  well  marked  at  the  end  of  thirty-six  hours,  and  have  known  it  make 
its  first  appearance  as  late  as  the  eighth  day.  At  first,  it  is  hardly  discern- 
ible. It  is  generally  seen  forming  at  the  centre  or  on  the  sides  of  the  glass, 
presenting  a  delicate  milky  or  bluish  white  aspect.  It  is  however  in  some 
cases  uniformly  disposed  over  the  surface  from  the  commencement,  and 
assumes  the  appearance  of  a  nearly  transparent  film,  which  gradually  be- 
comes more  distinct.  But  it  has  not  always  the  continuous  strongly  marked 
character,  which  some  have  ascribed  to  it.  I  have  seen  it  begin  in  striated 
irregular  lines,  somewhat  resembling  a  spider's  web,  in  rings,  circles,  trape- 
ziums, and  irregular  figures  of  almost  every  shape,  which  gradually  became 
obscured  by  the  full  development  of  the  pellicle. 

When  it  has  attained  this  stage,  which  occurs  generally  about  the  fifth 
day,  it  presents  a  continuous  scum  of  an  opaline  white  or  creamy  appear- 
ance, with  a  slight  tinge  of  yellow,  which  gradually  becomes  deeper  and 
more  decided.  The  uniformity  of  this  colour,  however,  is  generally  broken 
by  granulated  spots  of  a  clearer  white,  giving  it  a  dotted  or  roughened  aspect. 
The  crystals  of  the  forming  stage  now  appear  like  shining  points,  and  I  have 
sometimes  found  numerous  small  brownish  specks,  sprinkled  over  the  sur- 
face, not  unlike  the  gratings  of  nutmeg.  It  is  at  this  period,  that  the  pel- 
licle may  be  compared  "  to  the  fatty  scum  of  cooled  broth." 

In  this  state  it  continues  for  some  time,  preserving  all  its  characters  un- 
broken. The  glass,  where  the  surface  meets  it,  is  discoloured  by  a  white 
opaline  ring;  and  a  series  of  such  rings,  varying  in  extent  from  a  line  to  the 
fourth  of  an  inch,  marks  the  descent  of  the  surface  during  the  progress  of 
evaporation. 

The  cheesy  odour,  mentioned  by  Dr.  Bird  as  a  valuable  aid  in  diagnosis, 
and  as  "  by  no  means  unfrequent  in  those  specimens  in  which  the  pellicle  is 
very  thick,"  I  have  found  in  but  seven  cases.  Many  pellicles  of  great  thick- 
ness were  entirely  without  it;  and  in  two  of  those  presenting  it,  the  pellicle 
was  thin  and  not  very  well  developed.  Drs.  McPheeters  and  Perry  were 
unable  to  detect  it  in  either  of  the  twenty-seven  cases  examined  by  them, 
and  I  have  found  it  unequivocally  developed  in  at  least  three  cases  in  which 
pregnancy  did  not  exist. 

The  pellicle,  if  left  undisturbed  for  some  days,  breaks  into  cracks,  com- 
mencing generally  from  the  central  portions,  but  not  always  extending  to  the 
edge  of  the  glass.  These  are  again  crossed  by  other  fissures,  and  the  pel- 
licle is  more  or  less  broken  up.  In  the  mean  time,  the  flakes,  which  have 
been  forming  from  the  commencement  of  disintegration,  have  their  edges 
depressed  into  the  fluid,  while  at  the  same  time  the  general  thickness  of  the 
pellicle  is  much  diminished;  and  this  depression  or  dip  gradually  increasing, 
the  depending  particle  is  detached,  and  sinks  slowly  to  the  bottom.  Its 
complete  disintegration,  however,  is  but  seldom  seen;  being  anticipated  by 
the  decomposition  of  the  fluid.  The  deposite  is  of  course  considerably  in- 
creased by  the  fallen  portions  of  the  pellicle,  and  is  found  irregularly  dis- 


1842.]  Kane  on  Kiesteine,  19 

posed  over  the  bottom  of  the  vessel;  but  as  I  have  remarked,  most  abundant 
on  the  side  farthest  from  the  light. 

I  cannot  agree  with  those  who  consider  this  deposite  as  presenting  well 
marked  distinctive  characters  to  the  eye,  and  I  certainly  have  not  found  it 
uniformly  coincident  with  the  approach  of  the  pellicle.  It  has  indeed  in 
many  cases  been  absent  at  that  period;  and  in  others,  until  augmented  by 
the  detached  pellicle,  I  have  been  unable  to  distinguish  it  from  the  very 
many  deposites  found  in  other  urine.  How  far  a  chemical  investigation 
may  give  it  value,  I  am  not  prepared  to  say:  although  its  liability  to  be  con- 
founded with  other  sediments  makes  it  practically  unavailable  as  a  test,  it 
offers  a  fine  field  for  microscopic  and  chemical  research. 

This  description  of  the  appearances  and  changes  of  the  pellicle,  though 
more  detailed  than  those  of  Nauche  and  his  followers,  still  applies  only  to 
the  better  defined  examples.  In  a  considerable  proportion  of  cases,  some 
of  the  phases  mentioned  are  not  to  be  found  together;  and  I  have  not  been 
able  by  the  most  careful  observation  to  discover  the  causes  of  variance.  This 
I  allude  to  here,  because  the  absolute  and  unqualified  language,  which  I  have 
met  elsewhere  upon  the  subject,  seems  to  me  calculated  to  mislead  the  un 
practised  inquirer. 

It  must  not  however  be  inferred  that  the  presence  of  kiesteine  is  determi- 
nable only  by  vague  and  undefined  characteristics.  On  the  contrary,  the 
tables  which  are  appended  to  this  dissertation,  will  show  that  they  are  as 
well  defined  as  most  pathological  phenomena,  though  like  them  they  some- 
times require  for  their  discrimination  a  practised  comparative  scrutiny. 

Tlie  table  marked  A  exhibits  a  condensed  record  of  my  observations, 
more  or  less  frequently  repeated,  on  the  urine  of  eighty-five  pregnant 
females.  Of  these,  as  will  be  seen,  sixty-eight  gave  a  well  marked  pellicle  of 
the  sort  called  kiesteinic,  eleven  gave  the  pellicle  under  a  modified  form,  but 
with  appearances  which  enabled  me  to  recognize  it  clearly,  and  six  gave  no 
pellicle  whatever.  Of  these  last,  one  was  labouring  under  mammary  abscess 
and  convalescing  from  typhoid  fever,  and  one  was  in  a  condition  of  extreme 
anaemia  from  repeated  uterine  hemorrhages;  but  the  others,  unless  they  suc- 
ceeded in  practising  reiterated  deceptions  on  me,  which  I  can  hardly  believe, 
must  be  regarded  as  absolute  exceptions. 

The  cases  in  the  table  were  all  of  them  observed  at  the  hospital,  and  were 
of  course  considerably  advanced  before  being  submitted  to  my  inspection.  I 
have  since,  by  the  courtesy  of  my  friends  in  the  city,  and  especially  of  Dr. 
N.  Benedict,  been  invited  to  examine  the  urine  of  several  patients  in  cases 
of  very  recent  yet  unascertained  pregnancies.  My  diagnosis  has  been  in 
every  case  successful,  and  I  have  detected  the  kiesteine  repeatedly  before 
the  second  period  of  suspended  menstruation.  I  found  it  in  one  of  these 
before  the  fourth,  and  in  another  before  the  fifth  week,  computed  from  the 
middle  of  the  preceding  period.  In  several  others  I  have  determined  it  be- 
fore the  end  of  the  third  month.     In  one  case  the  kiesteine  was  not  visible 


20  Kane  on  Kiesteine*  [July 

on  the  fourth,  fifth  or  seventh  week,  although  perfectly  manifest  on  the 
tenth. 

The  urine  of  unimpregnated  females  in  a  state  of  health  rarely  undergoes 
any  change  which  in  this  respect  can  be  misapprehended.  I  have  examined 
twenty-eight  cases  in  a  perfectly  healthy  condition,  and  have  sometimes 
known  pellicles  form  on  the  urine,  as  well  as  on  that  of  males;  but  the  dis- 
tinctive character  of  the  kiesteine  was  wanting  in  every  case. 

In  certain  pathological  conditions,  however,  discrimination  is  somewhat 
more  difficult.  The  pellicle  that  is  not  unfrequently  seen  on  the  urine  in  the 
last  stages  of  phthisis,  in  arthritic  diseases,  and  in  cases  of  metastatic  ab- 
scess, vesical  catarrh,  and  uterine  tumours,  has  points  of  resemblance  to  the 
kiesteinic  which  might  readily  mislead  the  unpractised.  With  reference  to 
this,  I  have  examined  a  large  number  of  cases  in  various  states  of  health  and 
disease,  and  noted  the  results;  but  it  may  not  be  necessary  to  give  more  than 
a  concise  summary  of  them. 

In  thirty  cases  of  phthisis  pulmonalis,  the  urine  of  four  presented  a  pelli- 
cle somewhat  like  the  kiesteine,  and  one  a  pellicle  bearing  a  strong  resem- 
blance to  it:  though,  more  unequally  and  irregularly  disposed,  and  thus  dis- 
tinguishable by  the  eye.  Fourteen  of  the  cases  were  in  the  latter  stages  of 
the  affection,  and  among  these  were  three  that  presented  the  pellicle. 

In  arthritic  diseases,  eight  cases  of  acute  rheumatism  and  a  large  number 
of  chronic  rarely  presented  any  well-marked  pellicle,  and  never  one  that 
could  be  confounded  with  the  kiesteinic. 

Sixteen  females  between  the  ages  of  sixty  and  one  hundred,  as  well  as 
ten  epileptics,  presented  no  change  that  could  give  rise  to  confusion. 

Numerous  blennorrhagic  and  leucorrhoeal  cases  were  likewise  examined. 
In  the  urine  of  these  an  increased  quantity  of  mucus  was  generally  present, 
disposed  in  flocculi,  as  M.  Becquerel  and  others  have  noticed,  but  this 
was  by  no  means  uniform.  In  most  of  them  the  pellicle  was  of  a  cloudy 
character,  much  obscured  by  rapidly  induced  decomposition.  In  only  two 
of  them  did  it  approach  in  appearance  the  kiesteine.  But  in  these  the 
resemblance  was  close;  the  most  remarkable  difference  being  in  the  manner 
of  its  formation,  which  was  apparently  referable  to  the  advance  of  decompo- 
sition. The  pellicle,  moreover,  was  thickened  by  depending  flocculi  of 
mucus,  which  gave  to  its  lower  surface  an  irregular  fungiform  appearance. 

The  particulars  in  which  the  kiesteine  differs  from  other  pellicles  regard 
the  manner  of  its  formation  and  departure,  even  more  than  its  appearance 
when  developed.  As  I  have  already  mentioned,  it  generally  begins  to  show 
itself  within  a  day,  or  at  furthest  within  two  days  after  the  discharge  of  the 
fluid,  and  advances  gradually  to  its  complete  development.  The  other  pelli- 
cles, on  the  contrary,  rarely  give  indications  of  their  approach  until  the  fluid 
has  stood  a  longer  time,  or  even  till  decomposition  has  supervened,  and  then 
form  with  rapidity.     I  have  known  them  entirely  defined  within  a  few  hours. 


1842.]  Kane  on  Kiesteine.  21 

The  kiesteinic  pellicle,  when  fully  formed,  has  almost  always  a  much  greater 
degree  of  tenacity  than  the  others:  I  have  often,  for  purposes  of  microscopic 
examination,  lifted  large  flakes  entirely  out  of  the  urine;  and  when  it  was 
well  defined,  this  was  easily  done:  with  the  others  it  was  never  practica- 
ble. It  seems  also  to  be  independent  of  putrefaction;  it  is  not  obscured 
for  some  time  by  the  disorganization  of  the  liquid  on  which  it  rests;  and 
the  characteristics  which  I  have  already  described  as  accompanying  its  dis- 
appearance are  very  seldom  simulated. 

The  appearances  which  I  have  observed  seem  to  point  directly  to  the  con- 
clusion, that  the  formation  of  the  kiesteine  is  unconnected  with  the  presence 
of  extraneous  pus  or  flocculent  mucus.  I  was  aware  that  these  and  other 
animal  matters  might  under  certain  modifications  give  rise  to  a  scum  upon 
the  surface,  the  "  cremor  urinae"  of  the  older  writers.  This  has  been  no- 
ticed by  M.  Becquerel,  as  especially  observable  in  leucorrhcea;  and  I  have 
observed  it  very  frequently,  not  only  in  that  disease,  but  in  cystitis,  gonor- 
rhoea, vaginal  and  uterine  hemorrhages,  and  immediately  after  delivery 
when  the  lochial  discharge  was  mingled  with  the  urine. 

By  the  kindness  of  Dr.  Stewardson,  I  have  had  the  opportunity  of  seeing 
M.  Becquerel's  recent  and  very  elaborate  work  on  the  "  Semeiology  of 
Urines,"*  and  I  have  been  struck  with  the  discrepancy  between  his  observa- 
tions and  my  own  in  several  particulars  connected  with  this  inquiry. 

After  remarking  that  the  urine  is  modified  in  its  appearances  by  the  con- 
stitutional changes  incident  to  pregnancy,  he  says,  that  it  often,  especially  in 
the  latter  period  of  gestation,  grows  palish,  diminishes  in  density,  containing 
less  solid  matter  in  solution,  and  partakes  of  the  general  anaemic  character  of 
the  patient;  and  that  it  also  often  remains  unchanged  after  exposure. 
Without  attempting  to  deny  the  presence  of  the  matter  denominated  kiesteine, 
he  is  not  prepared  to  admit  it,  but  refers  to  the  "  influence  of  a  certain 
quantity  of  mucus  on  decomposition"  as  capable  of  producing  the  appearance 
which  has  been  mistaken  for  it. 

I  cannot  avoid  referring  to  the  results  of  some  experiments,  which  appear 
to  me  to  be  at  variance  with  these  suggestions.  Many  of  the  specimens 
which  I  examined  had  been  first  submitted  to  filtration,  with  a  view  of  sepa- 
rating any  mucus  they  might  contain;  yet  in  every  case,  the  pellicle  formed 
with  the  same  regularity  as  when  this  precaution  had  not  been  resorted  to. 

It  was  formed  also  on  urine  which,  when  treated  with  acetic  acid,  pre- 
sented no  coagulation,  and  which  underwent  no  change  when  treated  while 
hot  with  alcohol.  And  in  many  cases,  where  the  urine  was  withdrawn  by 
the  catheter,  and  freed  of  course  from  the  possibility  of  vaginal  extermix- 
ture,  the  formation  of  the  kiesteinic  pellicle  was  uninterrupted.  I  can 
scarcely  believe,  that  in  such  cases  it  was  owing  to  the  presence  of  the  ex- 
traneous mucus. 

*  Reviewed  in  the  Number  of  this  Journal  for  January  last. 


22  Kane  on  Kiesteine,  [July 

The  observation,  too,  that  the  urine  becomes  paler  in  the  later  stages  of 
pregnancy  has  not  been  confirmed  by  my  experience.  The  urine  when 
deposited  embraced  a  great  range  of  colours;  the  different  shades  of  yellow 
with  more  or  less  intermixture  of  red  being  the  most  common.  The  degree 
of  its  transparency  also  varied  much.  But  towards  the  last  month  of  ges- 
tation, the  urine,  with  more  or  less  uniformity,  as  will  be  seen  by  the  tables, 
became  much  darker,  assumed  a  reddish  or  salmon  colour,  and  often  di- 
minished in  transparency.  This  change  has  been  noticed  by  the  ancient 
writers;  and,  although  not  invariable,  seems  to  me  deserving  of  more  atten- 
tion. 

Having  convinced  myself,  that  the  urine  of  healthy  females  undergoes 
during  utero-gestation  a  change,  which  is  indicated  by  a  pellicle  in  many 
respects  similar  to  that  described  by  Nauche,  and  also  that  the  urine  of  other 
states  might  in  some  rare  cases  require  for  its  distinction  a  careful  compar- 
ative scrutiny;  I  next  sought  to  determine  by  observation,  whether  the  kies- 
teinic  pellicle  occurred  in  other  conditions. 

The  well  known  fact  that  the  elements  of  the  milk  have  been  found  in 
the  urine, — the  opinion  of  some  physiologists,  that,  separated  from  the  blood 
and  existing  in  the  mammae,  it  may  during  gestation  be  reabsorbed  and  ex- 
creted by  the  kidneys, — and  more  immediately,  the  supposition  of  Dr.  Bird, 
that  the  kiesteine  was  owing  to  its  presence, — naturally  led  me  to  examine 
the  urine  during  the  various  conditions  of  lactation. 

By  resorting  to  the  nursery  wards  of  the  hospital,  at  that  time  containing 
a  large  number  of  patients,  and  subsequently  by  examining  all  the  delivered 
cases  of  the  obstetrical  wards,  I  was  enabled  to  observe  no  less  than  ninety- 
four  cases.     These  I  have  grouped  in  the  table  marked  B. 

The  results  establish  the  fact,  that  the  kiesteine  is  by  no  means  peculiar  to 
pregnancy;  and  they  have  at  the  same  time  an  important  bearing  on  cir- 
cumstances which  contribute  to  the  theory  of  the  production  of  this  pellicle. 

Of  the  ninety-four  cases  of  females  in  a  state  of  lactation,  forty-two  gave 
the  usual  urinary  changes  without  any  indication  of  the  kiesteine;  eight  pre- 
sented a  scum,  but  modified  or  imperfectly  formed;  while  forty-four  exhi- 
bited the  perfect  kiesteinic  pellicle,  as  well  developed  as  in  ordinary  cases 
of  pregnancy. 

The  conditions,  which  appeared  to  exert  an  influence  over  its  formation  or 
its  absence,  may  be  the  subject  of  a  few  remarks. 

Immediately  after  delivery,  and  during  the  lochial  discharge,  when  the 
urine  owing  to  its  intermixture  was  more  or  less  reddened,  a  scum  formed 
of  a  semi-transparent  hornlike  appearance,  marked  by  arborescent  figures  of 
a  sanguineous  tinge. 

In  the  interval  between  the  birth  of  the  child  and  the  free  establishment 
and  exit  of  the  lacteal  secretion, — of  twenty-three  cases  in  which  I  succeeded 
in  preventing  lochial  admixture,  fifteen  gave  a  kiesteinic  pellicle. 

After  the  more  immediate  sequelae  of  pregnancy  and  delivery  had  disap- 


1842.]  Kane  on  Kiesteine,  23 

peared,  when  the  secretion  of  the  milk  was  perfectly  established,  and  the 
mother  had  begun  to  suckle  freely,  it  appeared  in  two  cases  only. 

Of  the  large  number  of  cases  that  were  examined  during  lactation,  several 
gave  the  pellicle  well  marked,  when  there  was  no  lacteal  disturbance  to  ex- 
plain it.  In  these,  however,  the  breasts  were  full  and  even  turgid,  indicat- 
ing an  exuberant  supply  or  inadequate  withdrawal  of  the  secretion. 

Of  cases  in  which  the  flow  of  the  milk  was  prevented  by  mechanical  or 
local  obstructions,  as  in  mammary  abscess,  &c.,  eleven  in  number,  seven 
gave  the  kiesteine:  of  those  in  which  the  secretion  was  interrupted  or  par- 
tially suspended  by  constitutional  disturbances,  eight  in  number,  it  was 
given  by  only  three:  while  of  ten  healthy  females,  eight  at  the  period  of 
tveaning  exhibited  it  perfectly  well  defined. 

Four  of  these  who  had  presented  the  kiesteinic  pellicle,  while  weaning, 
had  their  milk  afterwards  regularly  withdrawn  by  the  cupping  glass  and  the 
mouth.  After  the  lacteal  secretion  had  been  in  this  way  freely  re-established, 
the  urine  was  again  examined,  and  no  pellicle  appeared.  Intermitting  the 
use  of  the  cupping  glass,  and  allowing  the  breasts  to  become  turgid  again, 
the  urine  of  two  again  presented  the  pellicle. 

These  results,  while  they  demonstrate  that  the  kiesteine  is  not  peculiar  to 
iitero-gestation,  indicate  also  its  unquestionable  connection  with  the  lacteal 
secretion.* 

Its  presence  during  pregnancy,  and  even  after  delivery,  until  the  milk  is 
freely  withdrawn  by  the  child;  its  very  rare  occurrence  during  uninterrupted 
lactation;  its  reappearance  when  the  discharge  of  milk  is  prevented,  but 
not  when  the  corresponding  secretion  is  arrested;  and  finally  its  return  for 
the  time  during  the  process  of  weaning,  and  its  occasional  absence  when 
that  process  is  intermitted;  all  these,  regarding  them  as  the  general  results 
of  the  observations  above  cited,  point  to  one  probable  conclusion, — that  the 
kiesteine  makes  its  appearance,  whenever  the  lacteal  secretion  exists,  and  its 
discharge  is  prevented  or  considerably  impeded.  I  am  confirmed  in  this 
judgment  by  its  perfect  consistency  with  the  theory  suggested  by  Dr.  Gold- 
ing  Bird,  in  the  Guy's  Hospital  Reports  for  April  1840. 

Having  described  this  pellicle  under  its  various  forms  and  conditions,  it 
may  be  proper  to  add  a  few  words  on  its  nature  and  properties. 

Dr.  Golding  Bird,  to  whose  interesting  observations  I  have  before  so  often 
alluded,  states  that  "  none  of  the  specimens  examined  by  him  were  coagu- 
lable  by  heat,  nitric  acid,  or,  with  but  one  or  two  exceptions,  by  acetic  acid." 

In  all  the  cases  mentioned  in  my  first  tables,  the  urine  w^s  submitted  to 
the  action  of  nitric  acid;  in  about  forty  to  that  of  heat;  and  in  many,  it  was 

*  With  reference  to  the  remark  in  the  text,  I  am  at  this  time  observing  the  urine  in 
some  cases  of  uterine  tumour,  and  in  other  conditions  which  exercise  an  influence  on  the 
mammary  secretion. 


24  Kane  on  Kiesteine.  [J"b' 

tested  with  the  ferro-cyanuret  of  potassium,  after  having  been  acidulated 
with  acetic  acid. 

Of  those  which  were  exposed  to  heat,  seven  presented  a  coagulum;  but  re- 
membering the  precautions  urged  by  Dr.  Rees*  to  prevent  the  earthy  phos- 
phates being  mistaken  for  albumen,  1  submitted  the  fluid  in  these  cases  to 
other  tests,  and  thus  found  that  of  the  seven  cases  apparently  albuminous, 
three  were  in  reality  phosphatic.  Four  only,  of  course,  were  to  be  regarded 
as  containing  albumen. 

Ammonia  gave  a  deposite  of  varying  density;  and  acetic  acid  in  several 
cases  caused  coagulation. 

The  urine,  tested  daily  with  litmus,  was  found  in  almost  every  instance 
to  be  faintly  acid,  up  to  the  time  of  disintegration  of  the  crust.  At  this  pe- 
riod, however,  it  undergoes  the  ammoniacal  development,  and  acquires 
well  marked  alkaline  properties,  which  probably  induce  the  disintegration. 

The  pellicle  itself,  treated  with  alcohol,  became  of  a  fatty  saponaceous 
character;  the  crystals  remaining  but  little  affected.  Treated  with  ammonia, 
the  granular  matter  was  partially  dissolved,  and  the  crystals  were  made  more 
manifest:  they  were  even  susceptible  of  isolation  by  careful  washing  and  fil- 
tration. Acetic  acid  destroyed  the  crystals,  and  reduced  the  accompanying 
matter  to  a  pultaceous  mass,  without  materially  altering  its  structure. 

In  the  present  state  of  physiological  chemistry,  but  little  can  be  determin- 
ed with  regard  to  the  nature  of  the  kiesteine,  and  its  very  doubtful  claims 
to  be  considered  as  a  new  principle.  The  absence  of  coagulation  by  appro- 
priate agents  indicates  in  a  measure  that  neither  caseum  nor  albumen  exists 
in  very  perceptible  quantities;  while  the  acid  reaction  up  to  the  moment  of 
disintegration  seems  opposed  to  the  idea  of  its  being  a  mere  attendant  upon 
increased  quantities  of  pus  or  mucus. 

Still,  these  with  other  as  yet  undetected  principles  may  be  constituents  of 
the  pellicle  itself;  and  the  question,  whether  any  matters  developed  in  it  are 
identical  with  the  caseum  of  the  milk,  must  be  determined  by  further 
observations,  made  perhaps  in  a  more  advanced  stage  of  science.  For,  in- 
dependently of  the  possibility  of  this  principle  occurring  without  the  inter- 
vention of  the  mammary  secretion  (see  Andral,  &;c.),  Orfila  himself  has 
acknowledged  his  inability  to  distinguish  the  caseum  from  other  organic 
matters;!  and  M.  Dumas  has  announced  a  substance  in  every  respect  simi- 
lar to  it,  as  one  of  the  ingredients  in  the  composition  of  pus. 

My  remaining  observations  were  microscopic.  I  employed  for  them 
during  the  earlier  stage  of  my  inquiries,  a  simple  Raspail  instrument,  with  a 
Wollaston  eye-glass;  but  the  few  results  which  I  feel  justified  in  detailing 

*  See  paper  on  "Real  and   supposed  pathological  conditions  of  the  urine,"  by  G.  O. 
Rees,  M.  D.,  Northern  Dispensary,  London.     Guy's  Hospital  Reports, 
t  Traite  de  Chimie,  &c. 


1842.]  Kane  on  Kiesteine.  25 

were  attained  by  an  excellent  Berlin  microscope,  belonging  to  Dr.  Goddard, 
and  which  he  with  great  kindness  assisted  me  in  using.  I  can  have  no  rea- 
son to  doubt  the  correctness  of  observations  made  under  the  guidance  of  so 
practised  an  observer;  but  owing  to  the  many  sources  of  fallacy  attendant 
upon  microscopic  evidence  generally,  I  do  not  venture  to  claim  for  these  the 
same  confidence,  which  is  due  to  my  examinations  by  the  unassisted  eye. 

The  pellicle,  taken  immediately  from  the  urine  on  a  glass  plate,  carefully 
introduced,  when  examined  with  a  magnifying  power  of  one  hundred 
diameters,  exhibited,  while  yet  moist,  a  well  defined  series  of  flakes  of  a 
somewhat  darkish  yellow,  made  up  apparently  of  minute  granules.  This 
appearance,  which  I  at  first  thought  to  consist  of  minute  globules  of  mucus 
or  pus,  was  at  once  recognised  by  Dr.  Goddard,  as  closely  resembling,  if 
not  identical  with,  the  granules  of  the  colostrum.  Having  with  some  diffi- 
culty procured  a  supply  of  this  fluid,  a  comparison  of  the  two  exhibited  still 
more  clearly  this  interesting  resemblance.  The  granules  of  the  kiesteine 
were  however  more  flattened  than  those  of  the  colostrum,  a  change  they 
might  readily  have  undergone  during  their  passage  through  the  kidneys;  but 
the  general  aspect  of  the  two  was  such  as  to  give  strong  evidence  of  their 
identity.* 

Connected  with  these  appearances,  and  sometimes  obscuring  them,  the 
kiesteine  presented  under  the  microscope  an  irregularly  disposed  amorphous 
matter,  sometimes  arranged  in  groups  of  granules  that  resembled  the  urate 
of  ammonia,!  and  sometimes  of  badly  marked  globules,  allied  to  those  of 
pus  or  mucus,  and  accompanied  by  laminee  resembling  epithelia.:}: 

Throughout  the  field  of  the  instrument  was  seen,  in  varying  numbers  and 
distribution,  a  series  of  rectangular  rhomboidal  prisms,  more  or  less  dis- 
tinctly marked,  and  strongly  refracting  light.  The  triangular  prisms  were 
also  occasionally  distinguished,  but  not  in  the  "  myriads"  seen  by  Dr.  Bird; 
and  sometimes  other  crystalline  forms  were  observed  in  addition  to  these. 
They  all  belong  most  probably  to  some  of  the  earthy  phosphates.  Not 
only  were  the  triangular  prisms  recognised  to  be  those  described  by  Dr. 
Bird,  as  belonging  to  the  ammoniacal  phosphate  of  magnesia,  but  by  com- 
paring them  with  the  microscopic  plates  of  Rayer  and  Vigla,  and  Mandl, 
(Etude  Microscopique  sur  I'Urine,)  many  others  were  discovered,  coincid- 
ing with  the  varied  forms  of  this  prominent  salt. 

On  treating  the  pellicle,  collected  as  for  examination,  with  acetic  acid, 
applying  a  gentle  heat,  and  then  carefully  washing  the  residuum;  the  crys- 
tals, as  in  a  similar  experiment  by  Dr.  Bird,  entirely  disappeared,  and  the 
graniform  masses,  somewhat  obscured,  presented  themselves  al(>ne.§     By 

*  This  resemblance  was  very  striking  upon  comparing  it  with  the  plates  of  M.  Mandl. 
t  See  Mandl,  Raspail,  and  Rayer. 

X  See  plates  of  Rayer  and  Vigla,  Encyclographie  Medicale,  Vol.  VI. 
§  So  completely  were  they  deprived  of  erystalline  matter,  that  in  a  similar  experiment 
by  Dr.  Bird,  after  illuminating  the  granular,  or — as  he  defines  it— the  "opaque  mass,"  with 

No.  VII.— .July,  1842.  3 


26  Kane  on  Kiesteine.  [July 

using  ammonia,  the  reverse  was  the  case.  The  crystals,  nearly  unaltered, 
remained  unusually  distinct;  while,  by  the  careful  addition  of  water,  the 
granular  and  other  matter,  much  softened,  was  readily  washed  away,  leaving 
the  supposed  triple  phosphates  remaining. 

When  the  pellicle  has  been  for  a  short  time  exposed  under  the  micro- 
scope, the  natural  salts  of  the  urine  are  developed  by  evaporation,  present- 
ing numerous  shining  crystals  of  varied  forms;  among  the  most  prominent 
of  which  are  the  triangular  and  the  obscurely  marked  hexagonal  prisms. 

The  cubic  crystals,  which  M.  Eguisier  describes,  as  present  in  the  true  pel- 
licle after  it  becomes  old,  I  have  never  seen.  In  a  few  cases  of  both  kies- 
teinic  and  other  pellicles,  a  hollow  four-sided  pyramid  was  obseived,  resem- 
bling the  chloride  of  sodium,  and  in  one  case  a  regularly  formed  cube.  This 
was  the  nearest  approach  to  the  appearances  mentioned  by  Eguisier. 

In  the  pellicle  not  kiesteinic,  the  peculiar  granular  arrangement  noticed  as 
so  strongly  resembling  the  colostrum,  was  in  no  case  present.  Amorphous 
darkish  masses,  accompanied  by  various  crystalline  forms,  were  seen  only. 
Where  much  discoloration  existed  from  sanguineous  or  lochial  intermixture, 
a  strong  resemblance  was  observed  to  the  globule  of  the  blood. 

The  shining  appearance  of  the  kiesteine  is  evidently  not  owing  to  fatty 
matter,  unless  under  very  peculiar  modifications.  Neither  do  I  think  it 
entirely  owing  to  the  numerous  crystals  of  the  triple  phosphates,  observed  by 
Dr.  Bird.  I  apprehend,  that  the  specimens,  in  which  he  found  them  so  abun- 
dant, may  have  been  exposed  for  soma  minutes  to  evaporation;  as  I  have 
remarked,  that  under  such  circumstances,  the  proper  salts  of  the  urine  de- 
velop themselves  rapidly  in  their  crystalline  forms.  I  would  rather  refer 
the  glossy  character  of  the  surface  to  the  presence  of  animal  matters  gene- 
rally in  the  pellicle,  without  adducing  either  its  fatty  elements  or  the  crystals 
on  its  surface  as  the  explanation. 

It  may  be  proper  that  I  should  close  this  paper  by  some  remarks  on  the 
value  of  the  kiesteine  as  a  diagnostic  of  pregnancy.  I  do  so  with  diffidence, 
for  my  opinions  are  not  sustained  by  the  judgment  of  the  more  experienced 
observers  who  have  preceded  me. 

I  cannot  regard  the  kiesteine  as  an  unerriyig  test  of  pregnancy.  I  have 
already  shown  that  it  is  present  under  other  conditions  of  the  system;  and 
even  where  pregnancy  exists,  I  am  satisfied  that  this  indication  is  not  always 
observable. 

I  am  convinced  too,  that  the  kiesteine  is  not  always  distinguishable  from 
other  pellicles  which  appear  on  the  surface  of  the  urine.  At  least,  I  am 
bound  to  say,  that,  in  the  absence  of  other  indications,  I  should  sometimes 
have  found  myself  unable  to  distinguish  between  them.     Not  that  they  are 

a  beam  of  polarised  light  and  analysing  the  ray  by  means  of  tourmaline,  not  a  trace  of 
colour  was  perceptible. 


1842.]  Kane  on  Kiesteine.  27 

generally  liable  to  be  confounded;  but  between  the  imperfectly  developed 
pellicle  of  the  one  character,  and  the  best  simulation  of  it  which  is  some- 
times presented  by  others,  the  distinction  is  too  slight  to  be  satisfactory  or 
unfailing. 

But  with  the  qualifications  which  these  remarks  imply,  I  have  no  doubt 
that  the  pellicle  which  has  been  denominated  kiesteine  is  among  the  best, 
if  indeed  it  be  not  the  most  certain,  of  the  earlier  indications  of  pregnancy. 
I  resorted  to  it  habitually  in  my  diagnosis  in  the  obstetric  wards  of  our 
hospital,  and  with  constantly  increasing  confidence. 

In  one  case,  I  felt  myself  at  liberty  to  direct  the  removal  of  a  patient  to 
the  working  ward,  who  claimed  the  privileges  of  pregnancy  in  round  terras, 
and  presented  all  the  other  symptoms  of  that  state  in  confirmation  of  her 
pretensions.  She  still  retains  the  suspended  catamenia,  enlarged  abdomen, 
&c.,  though  five  months  have  elapsed  since  the  birth  of  the  infant  was  pro- 
mised me  as  a  proof  of  my  mistake.  Other  cases  of  attempted  imposture, 
some  of  them  ludicrous  enough,  which  were  detected  by  the  same  means,  I 
have  collected  in  my  table  C. 

My  associates  at  the  hospital  have  not  unfrequently  amused  themselves 
by  presenting  for  my  inspection,  the  urinary  excretions  of  all  sorts  of  pa- 
tients, and  in  many  varieties  of  combination.  I  believe  they  will  bear  me 
witness,  that  my  reliance  on  the  kiesteinic  test  has  not  misled  me. 

Indeed,  the  cases  which  I  have  referred  to,  and  which  are  arranged  in 
series  in  the  accompanying  tables,  must  satisfy  an  unprejudiced  mind,  that 
there  is  something  well  worthy  of  the  obstetrician's  study  in  the  pellicles 
presented  by  the  urine  during  utero-gestation. 

The  result  of  my  observations  may  be  summed  up  in  the  following  gene- 
ral conclusions: 

1.  That  the  kiesteine  is  not  peculiar  to  pregnancy,  but  may  occur  when- 
ever the  lacteal  elements  are  secreted  without  a  free  discharge  at  the  mammae. 

2.  That  though  sometimes  obscurely  developed  and  occasionally  simu- 
lated by  other  pellicles,  it  is  generally  distinguishable  from  all  others. 

3.  That  where  pregnancy  is  possible,  the  exhibition  of  a  clearly  defined 
kiesteinic  pellicle,  is  one  of  the  least  equivocal  proofs  of  that  condition;  and 

4.  That  when  this  pellicle  is  not  found  in  the  more  advanced  stages  of 
supposed  pregnancy,  the  probabilities,  if  the  female  be  otherwise  healthy, 
are  as  20  to  1  (81  to  4)  that  the  prognosis  is  incorrect. 

Philadelphia,  January  28,  1842, 


28 


Kane  on  Kiesteine, 


[July 


(A) — Table  of  Cases  during  Utero- Gestation. 

Names. 

■u 

Condition  of 
Mammae. 

Appearance  when 
received. 

Remarks. 

Result. 

1 

UbI 

1 

M.  Biddee, 

24 

H 

Milk  exuding 

Salmon    yellow, 

Surface  gave  a  filmy  pel- 

Kiest. 

upon      pressure. 

turbid,    flocculent, 

licle  in  16  hours,  preceded 

on  3d 

Mammae     much 

and  with  no  depo- 

by   crystals.      No    well 

day. 

distended. 

sits 

marked  cloud  or  deposite. 

2 

S.  Gilbert, 

20 

88 

Milk  in  mammae  Deep  reddish  yel- 
fromthe  seventh  low.     Turbid,  and 

Crystalline  dots.    A  firm 
cream-coloured     pellicle 

K.  on  4th 
day. 

month. 

with  some  deposi- 
tion. 

on  4th  day,  covered  with 
nutmeg  like  specks. 

3 

M.  Hill, 

32 

7. 

No  milk. 

Transparent,   with 
a  deep  tinge  of  red. 
No  mucous  flocculi. 

The  shining  specks  pre- 
ceding the  formation  of  the 
pellicle  which    occurred 
on  the  2nd  day.  No  cloud. 

K.  on  2d 

day. 

4 

E.  Williams, 

25 

8. 

Milk   from   this 

Turbid  honey  yel- 

Surface covered  with  striae 

K.  on  3d 

time. 

low,  with  little  or 
no  deposite. 

of  a  deep  yellow,  a  firm 
pellicle  filling  up  the  in- 
terstices.   Odour  cheesy. 

day- 
cheesy. 

((           u 

(( 

9. 

((           (( 

Dirty  red,with  some 
deposition. 

Sides  of  glass  coated  by 
deposition.    Distinct  pel- 
licle on  fourth  day. 

K.  on  4th 
day. 

5 

S.  Dunken, 

17 

9. 

Milk  exuding  by 

Pale  glaring  white 

Pellicle  in  circles,  greasy 

K.  on 

pressure. 

flocculi. 

in  appearance,    and  not 

well  defined  until  the  5th 

day. 

Little  pellicular  change 

until  4th  day;  it  then  gave 

5th  day." 

6 

A.  Lippincott, 

36 

8.12 

No  milk. 

Salmon    yellow, 

K.  on 

much  deposite. 

7th  day. 

a  perfect  pellicle   about 

the  7th. 

7 

A.  Banks, 

37 

8.20 

Milk  by  cupping 

Salmon  colour  with 

A  good  type  of  the  pelli- 

K.  on  3d 

glass. 

deposition. 

cular   appearance.      Not 
perfect  until  the  4th  day. 

day. 

8 

H.  Walker, 

24 

7. 

Milk  a  few  days 

Turbid,  flocculent, 

A  well  marked    opaline 

K.  on  3d 

previous. 

and  with  a  copious 
deposite. 

cloud,  above  which    the 
pellicle,  much  modified, 
appeared. 

modified 

9 

M.  Yacely, 

24 

8.13 

No  milk,  but  ve- 

Turbid salmon  co- 

Stood for  12  days  without 

^1 
1    K. 

ry  turgid. 

lour,  but  very  scan- 

any pellicular  change. 

ty. 

((        (( 

u 

6. 

No  milk. 

Lighter,  and  nearly 

Stood    until  putrefaction 

transparent. 

took    place  without   any 
pellicular  manifestations. 

^\ 

10 

M.  Gallagher, 

39 

During 

No  milk. 

Reddish   yellow. 

Pellicle    not  continuous. 

K.  on  3d 

labour. 

with  much  floccu- 
1-ent  deposition. 

and  wanting  the  tenacious 
character  of  the  kiesteine. 

modified 

11 

M.  Delano, 

20 

8.11 

Milk    from    the 

Straw      yellow, 

Decided  pellicle  on  the 

K.  on  2d 

6th  month. 

bright  and  transpa- 
rent. 
Muddy  reddish  yel- 

2nd day. 

day. 

12 

E.  Buckley, 

40 

Day  of 

Milk  by  pressure 

An  irregular  striated  pel- 

Excep. 

deliv. 

low,  and  no  depo- 
site. 

licle;  no  crystals,  and  not 
such  as  to  warrant  me  in 
pronouncing  it  kiesteine. 
Regularly  formed  pellicle 

tion.  No 
K. 

13 

M.  Yorkley, 

20 

8. 

Milk. 

Pale  yellow,  nearly 

K.  on  3d 

transparent. 

—  thin  and  pale;    odour 

cheesy. 

Spider  like  lines  and  cir- 

cheesy. 

14 

S.  Miller, 

20 

7.6 

Milk  in  breast  at 

Reddish  yellow, 

K.  on  2d 

the  7th  month— 

nearly  transparent. 

cles,  yet  a  well  defined 

day. 

none  at  present. 

pellicle. 

Pellicle  characteristic. 

15 

C.  Ryter, 

17 

9th 

None. 

Bright  straw  yellow 

K.  on  3d 

-  no  deposite. 

day. 

16 

B.  M'Gurth, 

21 

9th 

Small   and  flac- 

Yellow tinged  with 

Pellicle  not  over  the  en- 

K on  1st 

cid  mammae. 

red,  and  very  tur- 
bid. 

tire  surface;    decomposi- 
tion rapidly  set  in. 

day  mo- 
dified. 

17 

A.  Weaver, 

21 

7. 

Copious     exuda 

Turbid  red,  with  a 

An  obscured  pellicle  on 

Doubtful 

tion  of  milk. 

deposite       coatine; 
sides  of  glass. 

2nd  day;  not  well  defined. 

K.  on  2d 
day. 

((        (( 

a 

8. 

((           (( 

Not  so  much  depo- 
sition. 

A  characteristic  pellicle 
on  the  3d  day. 

K.  on  3d 

day. 

18 

R.  Dawson, 

22 

Day  of 

No  milk. 

Muddy    red,    with 

The  urine  was  of  a  dark 

K.  on  5th 

deliv. 

much  deposite. 

brown  at  the  surface:  on 
the  2d  day  this  disappear- 
ed, and  on  the  4th  a  well 
marked  pellicle  appear'd. 

day. 

19 

C.  Scoby, 

24 

during 

Milk  at  the  7th 

Bright    ruby,    red 

Pellicle    very   thin    and 

NoK. 

labour. 

month. 

tinge    with    much 
transparency. 

filmy,  the   crystals  very 
numerous. 

1842.] 


Kane  on  Kiesteine. 


29 


Table  (A)  continued. 


Names. 

B'm 

geof 
ignancy 
months 
i  days. 

Condition  of 
Mammee. 

Appearance  when 
received. 

Remarks. 

Result. 

6 

l£.ai 

C.  Scoby, 

24 

4.20 

No  milk. 

Lighter  and  not  so 

Pellicle,  although  not  ve- 

K. on  4th 

transparent. 

ry  well  marked^still  kies- 
teinic 

modified 

20 

H.  Benal, 

24 

During 

None. 

Pale   whitish    yel- 

Surface  covered  with    a 

K.  on  1st 

labour. 

low,  translucent. 

cloudy  pellicle   from  36  day 

hours  after  deposite;  odour  cheesy, 

cheesy. 

Labouring  under  much  fe-  K.  on  4th 

U             IC 

(( 

7. 

((            a 

Very   turbid,    and 

tinged  with  red. 

brile  disturbance :    pelli-  day, 
cle,  though  not  well  mark- 
ed, is  still  present:   not 
cheesy. 

21 

E.  Hull, 

20 

^ 

No  milk. 

Straw    yellow- 
transparent. 

Mouldy  dots  on  surface;  K.  on 4th 
pellicle  forming    around  day 

them.     Very  damp  wea- 
ther. 

cheesy. 

u        « 

(( 

7th 

u         a 

Bright    straw   yel- 
low, with  a  few  floc- 
culi. 

Pellicle  advancing  regu- 
larly from  2nd  day. 

K.  on  4th 

day 

cheesy. 

22 

M.  Robinson, 

19 

9. 

No  milk. 

Purulent  or  mucoid 
very  turbid  yellow. 

Gave    no    acid   reaction  K  on' 3d 
with  the  litmus.   Pellicle  day. 
very  flat. 

23 

M.  Robinson, 
white    vene- 
real ward. 

a 

6th 

a         a 

Light  straw  yellow; 
transparent. 

Gave  a  well  marked  de-  K.  on4lh 
cided  pellicle,  preceded  day. 
by  crystals,  and  covered 
with  brown  nutmeg  dots. 

24 

C.  Clarke, 

30 

5th 

Milk  by  pressure 
from  one  mamma 

Bright  red;   nearly 
transparent. 

Gradual  and  characteris-  K.  on  3d 
tic.                                        day. 

25 

A.  M'Hugh, 

26 

7. 

Milk  in  breasts 
since  5th  month. 

Pale  light  translu- 
cent yellow. 

Kiest.  well  marked,  but! K.  on  2d 
not  in  a  uniform  stratum,    day. 

26 

M.  Curio w, 

22 

8. 

Milk   since   7th 
month. 

Turbid  red. 

The  pellicle  forming  with  K.  on  2d 
great  regularity;  moulding  day. 
on  3d  day,  owing  to  damp. 

27 

M.  Rider, 

6, 

No  milk  at  pre- 

Turbid red:  many 

Decomposition  after  sian-'  t^jl 
ding8days.    Extreme  an-  Ji   INo 
semia.  Alkaline  reaction.  kS  (K. 
Same  result.                       |S-j 

sent. 

flocculi. 

u         u 

a 

a             u 

Not  so  turbid. 

28 

A.  Clarke, 

8. 

Milk  by  pressure 

Deep  salmon  colour 
—some  deposition. 

Stood  for  3  days  without'K.on8th 
any  change:  it  then  exhi-;day. 

biied  the  crystals  and  a 

gradual  characteristic  pel- 

licle, well  formed  by  8th 

day. 

29 

M.  Ackland, 

7. 

Milk  at  present 

Straw  yellow  ting'd 

Stood  for  some  time  with- 

K. on  4th 

with  red. 

out  change.   A  pellicle  on 'day. 
4th  day.                                1 

30 

E.  Johnson, 

6. 

No  milk. 

Yellow     honied, 
translucent. 

A  modified  irregular  pel-  K  on  3d 
licle.                                    modified 

31 

J.  Garrigan, 

5. 

No  milk. 

Salmon  colour,  tur- 
bid, and  with  depo- 

A singular  tenacious  scum  K.  on  3d 
two  lines  in  thickness  and  modified 

sitions. 

of  a  deep  blue  colour. 

32 

S.  Dashur, 

30 

During 

Milk  from     last 

Deep  red,  translu- 

A well  developed  pelli- 

K. on  4th 

women's  out 

labour. 

pregnancy,       18 

cent. 

cle. 

day. 

wards. 

months  previous. 

33 

L.  Hauwick, 

25 

6.25 

Milk  one  week 

Straw    yellow — 

Decomposed  rapidly— a 

K  on  2d 

afterquickening. 

transparent. 

very  copious  deposite  and  day. 
tolerably  marked  pellicle 
were  observed. 

34 

M.  Stratton, 

30 

9. 

No  enlargement 
and  no  milk. 

Straw  yellow,  with 
flaky  masses. 

No  very  evident  crystals.  K.  on  5th 
day. 

35 

M.  A.  Bowers, 

23 

7.14 

Milk  at  and  du- 
ring last  month. 

Red,    with    lateri- 
tious  deposite. 

No    pellicle   whatsoever  K.  on  3d 
until  3d  day.                        jday. 

36 

M.  B.  Mark. 

18 

7.19 

Milk  from  her  8th 
month. 

Reddish    yellow— 
no  deposition. 

The    cloud  like    appear- .K.  on  4th 
ance  preceded  the  charac-  day. 
teristic  pellicle. 

37 

E.  Wilkinson, 
or  Atkinson, 

41 

9. 

No  milk. 

Purulent  yellow, 
with  copious  depo- 
site. 

Litmus  gave  no  acid  reac-  Excep- 
tionr  fefrocyanuret  oiT^o-tion. 
tassium    and    heat    gave  No  K. 
coagulation. 

38 

M.  Stevens, 

34 

8.20 

Milk  by  pressure 

White  glaring  and 
pale. 

A  very  thin  buthighly  cha-l  K.  on  1st 
racteristic   pellicle,   with  day 
cheesy  odour.                     j  cheesy. 

39 

M.  Sailers, 

29 

9. 

Milk  by  pressure 

Reddish  yellow. 

A  thick  pellicle,  not  pre- K.  on 4th 
ceded  by  crystals.               day. 

30 


Kane  on  Kiesteine, 


[July 


Table  (A)  continued* 


Names. 

i^ 

age  of 
egnancy 
months 
id  days. 

Condition  of 
Mammae. 

Appearance  when 
received. 

Remarks. 

Result. 

40 

^^ 

cc^as 

M.  Hero, 

15 

6.16 

Distended      and 

Reddish  yellow, 

Presented  for  the  two  first 

K.  on  3d 

exuding  milk. 

translucent      with 
flocculi. 

days  the  acicular  crystal- 
line specks;  on  the  third 
day  the  pellicle,  and  on 
the  fifth  well  marked  nut- 
meg like  spots. 

day. 

((        (( 

15 

9. 

((          (( 

More  turbid;  colour 
very     nearly     the 
same. 

Crystals,  creamy  pellicle, 
&c.  at  their  greatest  deve- 
lopment on  5th  day. 

K.  on  2d 

day. 

41 

A.  M'Cully, 

22 

7.14 

Large  and  exud- 

Pale straw  colour, 

Surface  marbled  on  2nd 

K.  on  6th 

ing  the  mi!k. 

rather     dim,     yet 
transparent. 

day;  crystals  also  evident; 
pellicle  on  3d:  by  6th  day 
well  marked. 

day. 

42 

S.  Palmer, 

19 

6. 

No  milk. 

Dim,    transparent. 

A  horn  like  or  waxen  pel- 

K. on  4th 

honied  yellow. 

licle,    crystalline  _pom^s  day  mo- | 

interspersed. 

dified. 

u        a 

(( 

During 

Abundantsupply 

Red,  highly  colour 

Urine  highly  coloured- 

NoK. 

labour. 

of  milk. 

ed,  with  lateritious 
deposite. 

presented  a  horny  pellicle 
with  white  striae  intersect- 
ing it. 
Minute  crystals  on  the  1st 

43 

B.  Devine, 

20 

5.27 

Milk. 

Salmon  colour. 

K.on4ih 

day;  surface  studded  on  day. 

2d;  cloudy  appearance  on 

3d;  pellicle  on  4lh. 

Uniform  scum;    crystals  K  on  3d 

44 

M.  M'Guire, 

23 

8. 

No  milk. 

Bright    straw   yel- 

low, clear. 

not  very  evident,                day. 

((                   K 

2  days 

Very  tense,  but  Garnet  colour,  with 

Athickconsistentpellicle|K.  on  2d 

previous 

no  exudation  of  a  few  flocculi. 

formed  on  2nd  day,  slight-  day. 

milk. 

ly  tinged  with  red,  one 
line  in  thickness. 

45 

E.  Hastley, 

36   4mos. 

Distended. 

Translucent,     red, 
with  some  deposi- 
tion. 
Clear  cider  yellow; 

A  characteristic  ^creamy' 
pellicle. 

K.  on  4th 
day. 

46 

A.  Hutchins, 

19   4mos. 

Mammary  ab- 

A cloud  on  the  2nd  day. 

K.  on  3d 

scess,  with  fistu-  some  deposite. 

preceded  by  crystals,  and  day.        | 

lous  orifices. 

followed  by  a  pellicle  with 
brown  dots. 

47 

A.  Graves, 

25    6mos. 

Distended. 

Brownish    ochre 

Does  not  redden  litmus  pa-'Excep- 

yellow,  with  much 

per:  decomposition  com-Hion. 

deposite. 

mencedon2ndday:  gives  No  K. 

no  pellicle. 

48 

H.  Thompson, 

20    6mos. 

Tumid,    but   no  Slight  muddy  yel 

Presented   no   pellicle 

1 

milk. 

low;  quantity  20  oz. 

whatever:  found  on  inqui- 
ry that  it  was  voided  in 
the  afternoon. 

,K.  on 
f  3d  day 

((           (( 

a 

9. 

((           (I 

Straw  yellow,  mud- 
dy. 

Presented  a  well  marked 
pellicle  on  the  3d  day 
Little   change   until    4th 

J 

49 

J.  M'Cartney, 

39 

8.10 

Turgid,   but  ex- 

Greenish or  citrine 

K  on  5th 

uding  milk. 

yellow. 

da,y:  pellicle  perfect  on 

day. 

(C                     t( 

11 

((           « 

Clear  cider  yellow. 

Pellicle  apparent  on  2nd  K.  on  2d 
day:  at  its  maximum  on  day 

7lh:  odour  cheesy. 

cheesy. 

50 

S.  Fisher.     . 

24 

7.20 

Milk. 

Clear  cider  yellow, 
trans. 

Milky,  opaline  or  white 
pellicle  on  3d  day. 
iPellicle  on  3d  day;  odour 

K  on  3d 
day. 

51 

A.  Lenam, 

40 

8.20 

No    milk,  but  Xight  reddish,  cider 

K.  on  3d 

tense. 

yellow,  flocculent. 

cheesy,  but  very  slightly 

so. 

Pellicle  on  3d  day,  soon 

day. 

52 

M.  Gilbert, 

24 

6.25 

No  milk. 

Reddish  yellow  and 

K.  on  3d 

no  deposite. 

obscured   by    decomposi- 
tion. 
Well  marked  on  2nd  day 

day. 

u          <e 

(( 

((        (( 

Deep  red,  with  floc- 

K on2d 

culi. 

with  crystals,  specks  and 

day. 

_ 

fat  like  appearance. 

53 

M.  M'Mename 

20 

7.21 

Left  mamma  ex-jLight  cider  yellow. 

Peculiar  pellicle  arranged 

II  No 
1  fK. 

udes  milk:    ab- 

in striae  and  in  circles— 

scess  in  right. 

not  the  kiesteine. 

«             u 

« 

Rather  dusky. 

Same  result. 

^J 

54 

C.  Smith, 

23 

7. 

Milk. 

Bright   straw   yel- 
low. 

Pellicle  regularly  formed 
on  2nd  day;  cheesy  on  5th. 

K.  on  2d 

cheesy. 

65 

M.  Moody, 

23 

8.16 

Milk   since  her 

Reddish  yellow. 

A  well  marked  pellicle 

K.  on  3d 

3d  month. 

somewhat  brown. 

studded  with  crystals. 

day 

((        « 

((           (( 

Same  with  flocculi. 

Voided  a  few  hours  before 
delivery:  decomposed  ra- 
pidly but  the  pellicle  well 
marked. 

K.on2d 
day.      , 

1842.] 


Kane  on  Kiesteine. 


31 


Table  (A)  continued. 


Names. 

S  m 

Stage  of 
Pregnancy 
in  months 
and  days. 

Condition  of 
Mammee. 

Appearance  when 
received. 

Remark. 

Result, 

i 

tl 

56 

M.  Schuyler, 

29 

Day  of 

Week  before  de- 

Honey yellow,  ra- 

Decomposition about  the 

Modi. 

delivery 

livery  had  milk 
in  mammae. 

ther  turbid. 

3d  day:  pellicle  ramiform 
and  not  regularly  disposed 

fiedK. 

((            « 

((                u 

Same,  rather  more 
transparent. 

No  pellicle  until  4th  day, 
and  then  very  feebly  de 
veloped. 

K.  on  4th 
day. 

57 

H.  Charles, 

30 

9. 

Milk   since  7th 

Reddish   yellow, 

Pellicle  formed  regularly 

K.  on  2d 

month. 

some  deposite. 

from  2nd  day. 

day. 

m 

M.  Parker, 

20 

8  days 

No  milk,   but 

Transparent,     gar- 

Pellicle  in  circles  incrust- 

K.  on  3d 

previous 

much  distended. 

net  colour. 

ing  sides  of  glass. 

day  mo- 
dified. 

.0  deliv. 

59 

M.  Milnor, 

30 

7.28 

Milk  upon  pres- 

Clear straw  yellow; 

Milky,  dotted  and  charac- 

K.on4lh 

sure. 

no  deposite. 

teristic  pellicle— cheesy. 

day. 

GO 

M.  Collins, 

20 

6. 

U                  (( 

Abundant  lateri- 
tious  deposite. 

Striated,  glazed,  unsatis- 
factory pellicle. 

K.  on  5th 
modified 

61 

E.  Connor, 

20 

7.10 

Milk  in  mammae 

Palish   water    yel- 

Minute   doited    pellicle, 

K.  on  3d 

from  3d  month. 

low;  muddy. 

kiesteinic  but  very  thin. 

day. 

62 

A.  Petsai, 

30 

6 

No  milk. 

Deep  red,  with  floc- 
culi. 

Characteristic. 

K.  on  5th 
day. 

63 

A.  Mason, 

7. 

No  milk. 

Light  reddish. 

The  brownish  nutmeg 
specks. 

K.  on  3d 
day. 

64 

H.  Conway, 

61 

No  milk. 

Transparent  bright 
ruby  red. 

Regularly  formed;   stood 
14  days  without  disinte- 
grating            _ 
In  circles,  havmg  a  corru- 

K. on  2d 

day. 

65 

E.  Hutten, 

5. 

Milk  exuded  in 

Transparent  red,  as 

K.  on  3d 

3d  month. 

above. 

gated  aspect. 

day. 

66 

H.  Anderson, 

18 

7. 

No  milk. 

Flocculent  red. 

Not  uniformly  disposed. 

K  on  3d 
modified 

«           (( 

u 

7| 

Milk. 

((                    u 

A  well  marked  pellicle  on 
3d  day. 

K.  on  3d 

day. 

67 

E.  Jeansire, 

20 

6| 

Milk  a  week  pre- 

Bright   straw  yel- 

Opalescent    regularly 

K.  on  3d 

viously. 

low. 

formed  pellicle. 

A  well  defined  cloudy  de- 

day. 

68 

M.  Miller,* 

32 

3  trials  of 

Trifling     altera- 

Flocculent red. 

NoK. 

2  weeks, 

tions. 

posite,  but  no  kiesteinic 

7  weeks, 

pellicle. 

&  3  mos 

69 

Mrs.  C.  G-m, 

35 

Full  21 

Full  and  turgid. 

Cider  yellow;  very 
flocculent 
Straw  yellow. 

Gave  a  well  marked  K. 

K. 

70 

Miss  Baker, 

21 

10th 

No  changes  in 

Accompanied     by   the 

K.  on  3d 

week. 

conformation. 

brownish  specks. 

day. 

71 

E.  Black, 

161 

6  weeks. 

Enlarged  slight- 

Bright  honey  yel- 

A well  formed  kiesteinic 

K.  on  2d 

ly  ;    no    marked 

low. 

pellicle  on  2nd  day.     • 

day. 

characteristics. 

72 

M.  Alexander, 

36 

8  mos. 

Milk  by  syringe. 

Flocculent. 

A  well  marked  pellicle 
preceded  by  the  crystals 
and  sediment. 

K.  on  3d 
day. 

73 

M.  A.  Cornell, 

22 

7  mos. 

Milk. 

(( 

Kiesteine  with  great  te- 
nacity on  4th  day. 

K.  on  4th 
day. 

74 

M.  M'Canny, 

19 

6  mos. 

Turgid  and  with 
milk. 

Turbid  straw  colour 

Well  marked  kiesteine— 
alkaline  with  litmus. 

K.  on  2d 
day. 

75 

S.  Sharp, 

25 

5. 

No  milk. 

Very  viscid. 

But  a  well  marked  pel- 
licle. 

K.  on  2d 
day. 

76 

M.  Richardson, 

21 

8. 

No  milk. 

Obscured  dark  red. 

Bronchitis,  urine  alkaline 
and  no  pellicle 

NoK. 

«                   C( 

" 

(( 

Milk. 

Lighter  colour  and 

Gave  a  modified  pellicle. 

Mod.  K. 

77 

A.  Thompson, 

30 

9. 

Milk. 

transparent. 
Ruby  red 

Well  marked  pellicle. 

K.on3d. 

78 

S.  Spangler, 

26 

8. 

Turgid  and  exud- 
ing milk. 

Flocculent. 

Firm  consistent  pellicle. 

K.  on  3d 
day. 

79 

S.  Carey, 

23 

5. 

Milk. 

Honey  yellow. 

Well  marked  kiesteine. 

K.  on  4th 

80 

M.A.Andrews, 

22 

7. 

Milk. 

Turbid. 

K.  on  3d;  no  deposition 
evident  to  the  eye. 

K.  on  3d 

day. 

81 

S.  Ford, 

28 

9. 

No  milk. 

Highly   coloured- 
ruby  tinge. 

K.  on  5th. 

K.  on  5th 
day. 

82 

M.  A.  O'Neill, 

25 

7. 

Turgid  with  m'k. 

Flocculent. 

Well  marked  pellicle 
with  cheesy  odour. 

K.  on  4th 
cheesy. 

83 

J.  Scantlen, 

22 

7. 

Milk. 

Muddy  straw  colour 

Somewhat  striated,  yet  a 
characteristic  scum. 

K.  on  1st 
day. 

84 

E.  Dougherty, 

27 

a 

Milk. 

Reddish  do. 

Consistent  pellicle. 

K.on2d. 

85 

M.  Thompson, 

32 

3. 

Milk. 

Clear  straw  colour. 

Modified  by  striae. 

Mod.  K. 

*  Found  after  these  results  were  in  type  not  to  be  pregnant. 


32 


Kane  on  Kiesteine. 


[July 


(B) — Cases  during  Lactation, 


1 

Names. 

Age. 

Time  after 
Delivery. 

Condition  of  Mammae 

Remarks. 

Result. 

S.  Miller,             1 

20 

2  months. 

Freely  withdrawn. 

No  pellicle. 

NoK. 

2  C.  Ryter, 

17 

2  weeks. 

u              u 

li            u 

No  K. 

3  B.  M'Gurth, 

21 

6  weeks. 

((                 u 

i(         « 

No  K. 

4  A.  Weaver, 

21 

8  hours. 

Rather  turgid,  but  ex- 

Before establishment  of  the 

No  K. 

uding  milk. 

lacteal  secretion  on  the  ap- 
plication of  the  child  to  the 
breast. 

5,R.  Dawson, 

22 

2  weeks. 

Freely  suckling. 

No  pellicle  whatsoever. 

No  K. 

<(        (f 

" 

3  months. 

u               u 

No  change. 

No  K. 

e'c.  Scoby, 

24    1  week.         | 

H                    11 

No  change 

No  K. 

7|H.  Benel, 

24 

72  hours. 

Milk   not   yet  with- 
drawn. 

Immediately  afterbirth  gave 
a  red  horn  like  pellicle. 

No  K. 

8  E.  Hull, 

20 

4  days. 

Freely  suckling. 

No  change. 

NoK. 

9  M.  Robinson, 

19 

Iday. 

Large,  tumid,  and  but 
little  milk. 

One  day  after  birth  of  a  still- 
born child  rather  sanguine- 

K. on  4th  day. 

10  C.  Clarke, 

30 

2  months. 

Withdrawn  freely. 

ous. 

No  change  by  pellicle. 

No  K. 

11 

A.  M'Hugh, 

26 

1  month. 

It                        u 

((            u                 u 

No  K. 

12 

M.  Curlew, 

22 

3  weeks. 

((                     u 

((            ((                  u 

No  K. 

13 

M.  Ryder, 

1  month. 

((                       u 

((         ((             li 

No  K. 

14 

A.  Clarke, 

1  or  2  months 

Mammae    large    and 
secretion  scanty. 

Secretion   much    disturbed 
from  a   gastro-enteritic  at- 
tack. 
No  pellicle  resembling  K. 

No  K. 

15 

M.  Aiklyn, 

4  months. 

Freely  withdrawn. 

No  K. 

16 

E.  Johnson, 

6  months. 

((                        K 

"                     " 

No  K. 

17 

J.  Garrigan, 

3  weeks. 

Much  inflamed  and 
swollen. 

Inflammationof  the  papillae 
—gave  a  well  defined  pelli- 
cle on  4th. 

K.  on  3d  day. 

18 

S.  Dashur, 

18  months. 

No  exit  to  milk. 

While  weaning  on  3d  day. 

NoK. 

19 

L.  Hawick, 

3  months. 

Freely  emptied. 

Milk  plentiful  and  regular- 
ly withdrawn. 

NoK. 

20 

M.  A.  Straton, 

2  months. 

Painful,  and  no  milk 
visible. 

Severe  bronchitis;  secretion 
much  impeded. 

K.  on  3d  day 
cheesy. 

21 

M.  Bowers, 

4  weeks. 

Milk  freely  withdr'n. 

No  change. 

NoK. 

22 

M.  Mark, 

2  months. 

Pellicle  on  4th  day. 

K. 

23 

E.  Wilson, 

il            u 

IC              «                        « 

No  pellicular  change. 

NoK. 

24 

M.  Stevens, 

3  months. 

No  milk. 

Gastritis;  no  pellicle. 

NoK. 

25 

M.  Salters, 

4  months. 

((          ((                a 

No  pellicle. 

NoK. 

26 

M.  Hero, 

15 

3  days. 

Large  and  distended; 
no  exudation. 

4  days  after  birth  gave  a  red 
horny  pellicle. 

NoK. 

((         a 

(( 

((    « 

Milk  scanty  and  bad- 
ly withdrawn. 

A  febrile  attack  (gastritic) 
gave  a  modified  pellicle. 
Free  discharge,  &c. 

K.  modified. 

u         a 

(( 

a     11 

Freely  emptied. 

No  K. 

27 

A.  M'Cully, 

22 

3  hours. 

Large,  and  no  exuda- 
tion. 

Carefully  withdrawn  before 
secretion  was  well  establ'd. 

K.  on  4th  day. 

<(         (( 

(( 

3  months. 

a                (( 

"           "        but  no  K. 

NoK. 

28 

S.  Palmer, 

19 

4  days. 

Large,    and   badly 
emptied. 

During  lochia  a  horny  scum. 

NoK. 

u         a 

3  months. 

Freely  emptied. 

Freely  nursing. 

Cheesy  K. 

29 

B.  Devine, 

20 

3  weeks. 

Turgid,  full,  and  no 
exudation. 

Had  not  had  her  breasts  well 
emptied  for  48  hours 

K.  on  4th  day. 

30 

P.  Bunting, 

4  weeks. 

Red,  indurated,  and 
no  egress  to  secretion. 

Much  distension,  and  com- 
mencing mammary  abscess. 

K.  on  3d  day. 

31 

M.  Biddee, 

24 

6  hours. 

Natural,  and  exuding 
milk. 

6  hours  after  delivery  yield- 
ed a  true  pellicle. 

K. 

32 

S.  Gilbert, 

20  i4  weeks. 

Freely  emptied. 

No  pellicle. 

NoK. 

33 

M.  Hull, 

32  j3  weeks. 

a              u 

a         i< 

No  K. 

34 

E.Williams, 

25  i  Not  known. 

u             « 

((          (( 

No  K 

35 

M.  Shrook, 

22 

13  m.  wean- 

Large, full  and  pain- 
ful. 

Weaning  her  child  3d  day. 

K.  on  3d  day. 

36 

Mrs.C.C.C. 

ing. 
Weaning. 

"                  «     2d  day. 

K.  on  4th  day. 

37 

C.  Saxon, 

28 

8  hours. 

Bieast  turgid. 

Immediately  after  birth  gave 
a  red  horn  like  pellicle. 

a         u 

Weaning. 

Natural,  not  very  full. 

While  weaning  3d  day. 

No  K. 

38 

H.  Black, 

22 

3  months 

Milk  tolerably  well !  Tumefaction  and  inflamma- 

Modified  K . 

withdrawn. 

ti on  of  mammae.    A  partial 
scum  was  presented. 

39 

S.  Compes, 

19 

8  hours. 

Turgid. 

Interval    between     com- 
mencement of  free  secretion 
and  delivery. 

No  K. 

"        " 

(( 

3  weeks. 

Scanty  milk. 

Acute  colitis  with  its  accom- 
panying fever. 
Breasts  freely  discharged. 

NoK. 

u        « 

(( 

4  months. 

Freely  withdrawn. 

NoK. 

40 

M.  O'Neil, 

25 

3  months. 

u                  u 

11                    U                        li 

No  K. 

41 

M.  Spillrine, 

20 

2  months. 

((                   a 

11              11                a 

No  K. 

43. 

M  M'Closky, 

23 

i6  months. 

ii                   (( 

11              li                (1 

NoK. 

1842.] 


Kane  on  Kiesteine. 


33 


Table  (B)  continued. 


43 

Names. 

Age 

Time  after 
Delivery. 

Condition  of  Mammae 

Remarks. 

Result. 

E.Wilkinson, 

41 

Weaning. 

Tense  and  full. 

2d  day  of  weaning  period. 

K.  on  3d  day. 

44 

E.Pugh, 

2  months. 

One  mamma  tumid, 
and  no  exit  to  milk. 

Injured  by  teeth  of  child. 

K.  on  2d  day. 

45 

M.  Martha, 

22 

4  days. 

Natural. 

Free  exit  and  well  secreted; 
presented  no  pellicle. 

NoK. 

46 

M.  Reilly, 

20 

48  hours. 

Mammae  distended. 

Withdrawn  by  catheter  48 
hours  after  delivery. 

K.  on  2d  day. 

47 

M.  M'Carty, 

39 

3  weeks. 

Freely  withdrawn. 

No  change. 

No  K. 

48 

S.  Duncan, 

17 

3  months. 

U                           ii 

a          ii 

No  K. 

49 

A.  Lippincott, 

36 

3  weeks. 

Breast  rather  turgid. 

Bronchitis  with   angina; 
much  lacteal  secretion,  but 
exit  impeded. 

K.  on  3d  day. 

50 

A.  Banks, 

37 

1  month. 

a           li           a 

No  pellicular  chanee. 

No  K. 

51 

H.  Walker, 

24 

8  hours. 

Large,  protrudiifg  and 
no  milk. 

Secretion  not  re-establ  ished; 
voided  with  care  yet  no  K. 

No  K. 

52 

M.  Yaseley, 

24 

48  hours. 

((             a          a 

48  hours  after— milk  not  yet 
withdrawn. 

K.  on  3d  day. 

53 

M.  Gallagher, 

39 

3  days. 

Milk  freely  secreted 
and  withd'n  by  child. 

No  Kiesteine. 

No  K. 

54 

M.  Delano, 

20 

5  days. 

a          a        ■'    a 

((            (( 

No  K. 

55 

E.  Buckly, 

40 

7  days. 

a         a              a 

((             a 

No  K. 

56 

M.  Yorkley, 

20 

10  days. 

a          a              a 

li              a 

No  K. 

57 

M.  M'Guire, 

23 

48  hours. 

Large,   tumid   and 
painful. 

Tested  36  hours  after  death 
of  child— gave  a  well  mark- 
ed pellicle. 

K.  on  4th  day 

cheesy. 

((             a 

<( 

1  week. 

Same;  less  distended. 

1  week  after  delivery  breast 
much  distended;  child  still- 
born. 

NoK. 

58 

E.  Hastley, 

36 

3  weeks. 

Entire  suspension  of 
the  lacteal  secretion. 

Inflammation  of  mammary 
glands  and  entire  suspen- 
sion of  secretion. 

K.  on  3d  day. 

59 

Mrs.  Ann  Hatch- 
ings, 

19 

4  days. 

7  fistulous  sinus. 

Peritonitis    and    mammary 
abscess. 

K.  on  2d  day. 

«(    "^  '     » 

1  month. 

Induration  and  one  or 
two  closed. 

Large  abscesses  with  7'  si- 
nous     orifices ;      secretion 
much  impeded. 

K.  on  2d  day. 

((            (( 

(I 

3  months. 

Partially  restored. 

Same  condition;   secretion 

restored. 

Immediately  after  delivery 

mammary   inflammation  & 

NoK. 

60 

A.  Graves, 

25 

24  hours. 

Commencing  ulcera- 

NoK. 

tion  and  no  exit  of 

milk. 

induration. 

it             K 

« 

Weaning. 

a                  li 

While  weaning. 

No  K. 

61 

H.  Thompson, 

26 

2  weeks. 

Freely  secreting  and 
well  withdrawn. 

Gave  a  well  defined  kiestei- 
nic pellicle,  rather  reddish. 

K.  on  4th  day. 

62 

J.  M'Cartney, 

39 

4  weeks. 

Flaccid   and  not  se- 
creting. 

General  anaemia;  secretion 
much  retarded. 

No  K. 

63 

S.  Fisher, 

24 

1  month. 

Freely  emptied. 

No  pellicle. 

No  K. 

64 

A.  Lenam, 

40 

Not  known. 

Distended. 

After  death  of  child. 

K. 

65 

M.  Gilbert, 

24 

10  hours. 

" 

Between    establishment   of 
the  secretion  and  birth. 

No  K. 

((        ii 

(C 

3  months. 

N"atural. 

Free  exit,  &c. 

No  K. 

66 

M.  M'Mename, 

20 

4  hours. 

Not  exuding. 

Immediately    after    birth 
carefully  withdrawn. 

K.  on  2d  day. 

67 

C.  Smith, 

23 

2  months. 

Natural 

Gave  no  pellicle. 

68 

M.  Moody, 

2d  month. 

Tumid,  large,  and 
suspended  secretion. 

Commencing  mammary  ab- 
scess; gave  a  well  defined  K. 

K. 

11              IC 

3d  month. 

Natural. 

Free  exit. 

No  K. 

69 

M.  Schuyler, 

29' 

36  hours. 

Natural. 

Dropped  her  child  while  on 
the  urinal— 36  hours  after. 
Natural,  &c.    No  pellicle. 

No  K. 

70 

H.  Charles, 

30 

10  days. 

Freely  exuding  and 
withdrawn. 

No   change   until    3d  day, 
when  a  well  marked  pelli- 
cle appeared. 

K.  on  4th  day. 

71 

M.  Parker, 

20 

5  months. 

Freely  withdrawn. 

No  change. 

No  K. 

72 

M.  Milnor, 

30 

2  months. 

a                a 

"        "        indicative  of  ki- 
esteine. 

No  K. 

73 

M.  Collins, 

20 

1  month. 

ii                a 

No  kiesteinic  change. 

No  K. 

74 

E.  Connor, 

20 

10  days. 

((                a 

Lochia  continue;  a  reddish 
pellicle' was  presented. 
Presented  no  change 

No  K. 

(I        (I 

(( 

2  months. 

li                a 

NoK. 

75 

A  Petsan, 

30 

20  days. 

Large,  tumid,  and  not 
secreting. 

Inflammation  and  tumefac-  No  K. 
tion  of  mammae.                     1 

76 

A.  Mason, 

22 

1  month. 

Suspended  secretion. 

Peritoneal  inflammation.      !No  K. 

77 

H.  Conway, 

19 

15  days. 

Some  exudation  of  Mammary  abscess:  gave  a  K.  on  3d  day.    | 

milk.                             well  defined  kiesteinic  pel- 
licle. 
Breasts  freely  empt'd.j No  kiesteinic  change. 

78 

E.  Hutton, 

20 

1  week. 

NoK. 

34 


Kane  on  Kiesteine, 


[July 


Table  (B)  continued. 


79 

Names. 

Age. 

Time  after 
Delivery. 

Condition  of  Mammae- 

Remarks. 

Result. 

H.  Anderson, 

19 

5  days. 

Breasts  tumid,  large 

Child  lived  2  days:  a  well  K.  on  5th  day. 

and  tense. 

defined  pellicle  5  days  afteri 
birth.                                      1 
During  interval  of  birth  and  No  K. 

m 

E.  Jeansire, 

20 

10  hours. 

Not  exuding. 

free  exit. 

a          (I 

1  month. 

Well  withdrawn. 

Fully  and  freely  discharged  No  K. 

R1 

J.  Mills, 

24 

4  hours. 

Large,  yet  exud.  m'k. 

During  interval  no  milk.        No  K. 

Weaning. 

^u                       u 

While  v/eaning.                     ;No  K. 

R2 

H.  Minor, 

36  hours. 

Tense  and  no  milk. 

By  catheter,  during  interval.  K. 

83 

C.  Baker, 

20    10  hours. 

Tense,  yet  exuding. 

During  interval  between  ap-'No  K. 

plication  of  child  and  birth. 

84 

H  Willomeine, 

22 

Weaning. 

Full  and  turgid. 

While  weaning  gave  a  mo- 
dified pellicle. 

K.  on  3d  day 
modified. 

85 

C.  Van  Arsdale, 

22    2  years. 

Varying.  * 

Restored  by  glass:  no  kies- 
teine  while  weaning. 

No  K.  and  K. 

86 

C.  Cunningham, 

27  :  18  months. 

« 

While  weaning  restored  by 
cupping  glass. 

K.  on  1st  day. 

87 

Wilhermeine, 

22    After    death 
lof  child. 

(( 

Secretion  restored:  gave  no 
liiestine. 

NoK. 

((            (( 

IS  months. 

Full  and  turgid. 

Gave  a  well  marked  K. 

K.  on  3d  day. 

88 

S.  Ford, 

28    3  days. 

Full  and  turgid. 

Puerperal  peritonitis. 

NoK. 

89 

J.  Scantlin, 

22    36  hours. 

Flaccid. 

ii               li 

NoK. 

90 

E.  Andrews, 

18    4  days  after 
d'th  of  child. 

Large  and  distended. 

Pellicle  well  marked. 

K.  on  2d  day. 

91 

S.  Sharpe, 

25    4  days  after 
delivery. 

Large. 

No  marked  pellicle. 

NoK. 

92 

E.  Dougherty, 

27    10  days. 

Flaccid. 

Puerperal  peritonitis. 

NoK. 

93 

J.  Wilson, 

25    2  months. 

Freely  suckling. 

No  pellicle. 

No  K. 

94 

Mrs.  Dickenson, 

20    3  months. 

Freely  withdrawn. 

No  scum  nor  deposits.           No  K.                ] 

Summary  of  Besults  in  Table  B. 


Condition  of  Patient. 

Number 
Examined. 

Result. 

Obstructions^  mechanical  and  otherwise,  to  the  free  exit  of  the 

secretion,           

Suspension  and  obstructions  from  constitutional  disturbances, 
Interval  between  birth  and  the  free  exit  of  the  milk, 
During  vs^eaning,  in  various  conditions  of  the  lacteal  function. 
Lactation  suddenly  interrupted  by  death  of  child,  - 
During  unimpeded  and  natural  lactation,        ... 

Total  number  during  lactation  in  various  conditions, 

11 

8 
13 
10 

4 

48 

7  gave  the  K. 
3  gave  the  K. 
6  gave  the  K. 

8  g-ave  the  K. 
3  gave  the  K. 
5  gave  the  K. 

94 

32 

(C) — Exainples  of  Cases  tested  hy  the  Kiesteinic  Indication. 

1.  Helen  Anderson,  sstat.  18,  woman's  venereal  ward,  was  under  treatment  for 
commencing  secondary  symptoms,  attended  with  a  recent  gonorrhcea.  Her  habits 
were  extremely  irregular,  and  her  intercourse  had  been  for  the  last  eighteen  months 
promiscuous.  The  menses  had  during  this  period  been  much  ir>terrupted,  and  for 
the  last  twelve  months  were  entirely  suspended. 

Her  abdomen  attracting  attention  from  its  increased  size,  the  urine  was  submit- 
ted to  examination,  and  presented  a  well-marked  pellicle;  a  second  trial  gave  the 
same  result;  some  time  after,  she  was  removed  to  the  obstetrical  ward,  and  here 
delivered  of  a  premature  infant. 

2.  Mrs.  Mary  Welsh,  aetat.  37,  May  25th,  1841,  white  obstetrical  wards,  had 
been  for  tv^'o  years  an  inmate  of  the  women's  out-wards.  On  the  23d  of  July  she 
married  for  the  second  time,  having  had  by  her  former  husband  five  healthy  chil- 
dren. Some  months  after  her  marriage,  her  menstrual  function  was  somewhat 
deranged;  but  for  two  months  immediately  preceding,  and  for  three  after,  its  regu- 
larity was  uninterrupted.     Since  the  27th  of  October  her  catamenia  have  entirely 


1842.]  Kane  on  Kiesteine.  85 

ceased,  the  cessation  being-  unaccompanied  by  the  ordinary  indications  of  a 
"change  of  life."  Her  sensations  resembled  those  of  previous  pregnancies;  and 
on  the  following  March,  five  months  after,  she  distinctly  felt  the  motion  of  the 
child. 

Wishing,  in  the  course  of  my  observations,  to  procure  some  urine  from  preg- 
nant females  well  advanced,  I  sent  for  ten  specimens  of  which  there  could  be  no 
doubt,  and  included  this  woman  on  my  list.  I  was  surprised  to  find  that  her  urine 
presented  no  kiesteine^  and  submitted  it  in  consequence  to  another  trial;  and  this 
giving  the  same  result,  I  noted  the  case  as  an  exception,  and  so  mentioned  it  to 
Dr.  Dunglison  and  to  others. 

While  in  her  eighth  month,  however,  I  made  a  third  examination,  which  pre- 
senting also  no  pellicle,  led  to  a  close  investigation  of  her  case,  and  finally  to  her 
dismissal  from  the  ward  on  my  own  responsibility. 

That  there  were  many  evidences  of  pregnancy,  and  that  the  absence  of  the 
peculiar  pellicle  had  much  influence  on  her  discharge,  will  be  seen  from  the  sub- 
joined examination  made  in  the  eighth  month. 

Mammse. — Large  and  protruding;  much  developed;  nipple  prominent;  the  disc 
somewhat  tumefied,  and  the  general  condition  rather  firm  than  flaccid.  By  pres- 
sure, a  yellowish,  milky  fluid  exuded  from  the  breast,  and  the  papillae  were  quite 
mammelated  from  the  enlargement  of  the  follicles.  Mdomen.— Tumid,  and  much 
protruding,  the  rugae  of  previous  pregnancies  having  disappeared  by  the  tension; 
the  navel,  although  not  prominent,  was  not  depressed.  On  percussion,  generally 
flat,  but  tympanitic  around  the  umbilical  region.  Uterus  examined  per  vaginam, 
rigid,  rather  patulous  about  the  mouth;  vagina  very  rugose  and  contracted,  dry  and 
badly  lubricated.  By  auscultation  and  the  stethoscope,  I  made  out  no  foetal  pulsa- 
tion, although  opinions  were  divided  as  to  its  existence;  a  souffle  was  distinctly 
heard,  but  I  did  not  feel  myself  competent  to  decide  as  to  its  character.  By  bal- 
lottement,  no  result. 

After  carefully  considering  the  above  case,  I  discharged  her,  much  against  her 
own  wishes  and  those  of  her  fellow  patients,  to  the  female  working  wards,  where 
she  remains  at  the  date  of  this  paper  without  a  change  of  symptoms. 

3.  Isabella  Smith,  aetat.  25,  entered  the  white  obstetrical  wards  on  the  20th  of 
April,  1841,  professing  to  be  in  the  eighth  month,  and  presenting  so  many  indica- 
tions of  well  advanced  pregnancy  that  no  deception  was  suspected.  A  series  of 
epileptic  paroxysms,  which  prevented  the  usual  more  rigid  examination,  caused 
her  temporary  removal  to  the  women's  lunatic  asylum,  where,  on  the  morning 
after  her  admission,  I  procured  a  specimen  of  her  urine.  The  absence  of  a  pelli- 
cle on  two  trials,  made  at  the  instance  of  Dr.  Dunglison,  satisfied  me  that  she  was 
an  impostor;  and  on  the  28th,  during  a  well  simulated  paroxysm  of  epilepsy,  her 
dress  gave  way,  and  disclosed  an  abundant  mass  of  hair  padding  ingeniously 
arranged  over  the  abdomen. 

4. Black  obstetrical  wards.     This  woman  came  into 

the  ward  in  the  sixth  month,  as  she  supposed,  with  arrestation  of  the  menses, 
tumid  abdomen,  enlarged  mammae,  &c. 

At  the  time  of  procuring  the  first  specimen  of  her  urine,  I  was  assured  by  the 
nurse  and  herself  that  they  felt  the  motion  of  the  child.  No  indications  of  the 
kiesteine  were  present,  however,  and  a  second  trial  giving  the  same  result,  she 
was  dismissed  from  the  ward. 


36  Kane  on  Kiesteine.  [Ju^y 

5.  Mary  Patterson,  setat.  30,  in  the  women's  venereal  ward,  supposed  herself 
pregnant,  and  had  so  many  of  the  signs  as  to  render  her  case  an  undecided  one. 
Her  urine  gave  no  pellicle,  and  in  the  result  this  test  was  found  correct. 

6.  I  have  at  this  moment  before  me  a  letter  from  Dr.  T.  Lindsey  Walker,  of 
Va.,  one  of  my  colleagues  at  the  Philadelphia  Hospital,  to  whose  intelligent  inte- 
rest I  am  much  indebted,  in  which  he  states,  that  of  seven  specimens  of  urine, 
presented  under  fictitious  names,  and  at  a  distance  of  two  miles  from  the  place 
where  they  were  voided,  1  successfully  indicated  the  only  four,  which  were  those 
of  pregnant  females. 

7.  >S'.  C ,  aetat.  22.  Her  urine  was  presented  to  me  by  a  medical  friend,  re- 
questing an  opinion.  The  evidences  of  pregnancy  were  well  marked,  and  to  many 
conclusive.  Repeated  trials  of  her  urine  in  no  instance  gave  the  kiesteine,  and  sub- 
sequent examination  confirmed  the  accuracy  of  its  evidence:  she  was  not  pregnant. 

8.  Maria  Hero,  aetat.  15.  This  young  woman,  at  the  very  commencement  of 
my  experiments,  refused  to  give  me  her  urine;  and  when  at  last  I  succeeded  in  pro- 
curing a  specimen,  it  yielded  no  pellicle.  I  made  a  second  trial,  and  this  gave  the 
same  result.  Embarrassed  by  this  apparent  contradiction  of  the  other  indications 
in  her  case,  I  determined  to  make  a  third  trial,  and  obtained  a  perfectly  marked 
kiesteinic  pellicle.  I  learned  on  subsequent  inquiry,  that  she  had,  on  the  two  first 
occasions,  borrowed  urine  from  her  neighbour. 

This  was  only  one  of  very  many  cases  of  attempted  imposture  detected  in  the 
course  of  my  examinations. 

9.  Miss ,  setat.  23.     Applied  to  Dr.  N.  Benedict,  of  this  city,  for  a 

course  of  treatment  for  suppressed  menstruation.  Her  previous  character  had  been 
undoubted.  He  had  felt  an  interest  in  the  inquiries  which  I  was  conducting,  and 
sent  me  a  specimen  of  her  urine  for  examination. 

It  presented  on  the  third  day  the  kiesteinic  pellicle  so  well  marked  as  to  leave 
no  doubt  in  my  mind  as  to  the  proper  diagnosis  of  her  case.  Having  reported  to 
him  accordingly,  he  declined  administering  emmenagogues,  and  in  the  result  she 
reluctantly  confessed  herself  in  the  second  month  of  pregnancy.  She  is  now 
awaiting  delivery. 

With  another  case,  of  the  many  which  I  have  had  the  pleasure  of  determining 
for  the  same  gentleman,  I  will  now  conclude. 

10.  Mrs.  M M ,  aetat.  32.     Since  her  marriage,  which  occurred  five 

years  ago,  has  been  the  mother  of  three  children,  the  interval  between  them  being 
of  nearly  uniform  duration.  At  the  expected  period,  experiencing  well  understood 
symptoms,  she  supposed  herself  again  pregnant.  Her  urine,  tested  in  the  third, 
fifth,  and  seventh  weeks,  presented  no  pellicle.  Her  symptoms  were  now  aug- 
mented by  a  host  of  sensible  signs;  and  finally  a  fourth  trial,  made  after  averred 
quickening,  giving  no  kiesteine,  led  me  to  consider  her  case  as  an  exception,  and  to 
note  it  as  such  in  my  tables. 

Since  that  date,  however,  I  am  enabled  to  add  her  name  to  my  confirmatory  list; 
a  subsequent  examination  making  it  perfectly  evident  that  her  condition  is  owing 
to  other  causes. 

P.  S. — April  20,  1842.  Since  this  dissertation  was  submitted  to  the 
Medical  Faculty  of  the  University  of  Pennsylvania,  two  papers  on  this  sub- 


1842.]  Kane  on  Kiesteine.  37 

ject  have  appeared;  one  by  Mr.  Letheby,  in  the  London  Medical  Gazette  of 
Dec.  24,  1841,  and  an  elaborate  paper  by  Dr.  Stark,  in  the  Edinburgh 
Medical  and  Surgical  Journal,  for  January  of  the  present  year. 

The  facts  observed  by  Mr.  Letheby  accord  generally  with  my  own.  He 
found  "unquestionable  evidence  of  kiesteine  in  forty-eight  out  of  fifty  cases 
between  the  second  and  ninth  month  of  utero-gestation,"  and  was  unable, 
like  myself,  to  "  account  for  its  absence  in  the  two  exceptions."  In  seven- 
teen non-pregnant  women  he  found  no  indication  of  its  presence;  but  detected 
it  in, the  urine  of  ten  suckling  women,  immediately  after  delivery,  and  onwards 
to  periods  between  the  second  and  sixth  months,  when  it  disappeared.  The 
few  microscopic  results  which  he  gives  coincide  also  with  my  own. 

Dr.  Stark's  paper  is  devoted  to  the  signs  of  pregnancy,  and  among  the 
rest  to  the  state  of  the  urine.  He  refers  succinctly  to  his  own  observations 
relative  to  the  kiesteinic  pellicle,  which  he  supposes  to  be  derived  from  the 
suspended  sediment;  and  he  asserts  that  there  exists  a  relative  proportion  be- 
tween these  and  the  earthy  salts  which  enter  into  the  composition  of  the 
urine.  His  paper  derives  its  principal  interest  from  his  researches  into  the 
character  of  the  sediment. 

In  the  natural  sediment  of  the  urine  of  pregnancy,  he  was  unable  to 
detect  the  presence  either  of  albumen  or  caseum  by  acids,  alkalis,  or  al- 
cohol, with  the  aid  of  heat;  but  when  he  added  a  certain  quantity  of  milk  to 
the  urine,  both  these  principles  were  discovered  readily  by  the  aid  of  acids, 
the  other  tests  producing  no  effect:  when  milk  was  added  in  smaller  quan- 
tities, however,  it  was  undis  cover  able  by  any  reagent.  Being  unable  to 
refer  the  sediment  to  any  of  the  known  deposites  of  the  urine,  though  his 
investigations  had  immediate  reference  to  its  distinctive  characters,  he  em- 
ployed ether  to  effect  a  separation  of  the  animalized  matter  which  he 
thought  it  might  contain,  and  he  supposes  that  he  succeeded  by  this  means 
in  detecting  a  substance  entirely  different  from  any  heretofore  known. 

Failing  to  determine  its  constitution  by  chemical  agents,  he  resorted  to  the 
microscope.  He  here  found  that  this  sedimentitious  matter,  whether  ex- 
amined while  yet  held  in  solution  by  the  recent  urine,  or  when  it  had  assumed 
the  form  of  a  deposit,  or  when  it  had  been  disengaged  by  ether,  was  com- 
posed of  distinct  transparent  or  "  pellucid"  globules,  which  when  in  their 
sedimentary  condition  bore  a  striking  resemblance  to  the  caseum  globule  of 
recent  milk,  but  which  when  pellucid  bore  an  equally  strong  resemblance  to 
the  serous  or  albuminous  globule. 

Dr.  Stark  now  reduced  the  question  to  very  narrow  bounds,  by  inquiring 
as  to  the  identity  of  this  sedimentary  matter  with  albumen,  caseum,  fibrine, 
and  gelatine.  He  thinks  that  its  minute  structure  and  chemical  properties 
sufficiently  distinguish  it  from  the  two  first; — from  albumen,  because  it  dis- 
solves instead  of  coagulating  upon  the  application  of  heat;  from  caseum,  be- 
cause it  is  soluble  in  nitric  and  sulphuric  acids,  which  exert  on  this  principle 
a  very  contrary  action.  From  fibrine,  it  has  necessarily  a  still  greater  dif- 
No.  VII.— July,  1842.  4 


38  Kane  on  Kiesteine.  [July 

ference.  There  remains  gelatine;  and  compared  with  this,  the  distinction 
was  less  striking.  The  globules  of  both  under  the  microscope,  were  simi- 
larly formed:  both  were  soluble  in  the  acids  and  alkalies,  arid  by  the  aid  of 
heat.  The  only  distinctive  particular  seems  to  have  been  the  action  of  tannin, 
which  as  is  well  known  precipitates  gelatine  from  its  solution  in  water. 
Some  of  the  natural  sediments,  dissolved  in  boiling  water,  and  cooled  to  a 
blood  heat,  were  treated  with  a  decoction  of  galls:  a  flocculent  precipitate  was 
at  once  produced;  but  instead  of  gelatinizing  upon  cooling — it  ivas  deposited; 
and  instead  of  becoming  more  solid  and  more  easily  separable,  upon  reboil- 
ing,  it  again  underwent  solution. 

Upon  these  grounds  he  attains  the  conclusion,  which  I  give  without  com- 
ment, "  that  tbis  substance  is  a  matter  sui  generis <,  an  elementary  substance 
or  principle,  forming  in  some  measure  a  connecting  link  between  the  albu- 
minous and  gelatinous  elementary  principles."  This  substance  he  proposes 
to  designate  by  the  name  of  *'  Gravidine,^^ 

It  is  unnecessary  to  say,  that  this  discovery  of  a  new  organic  principle,  if 
confirmed  by  future  investigation,  will  be  a  matter  of  great  interest.  I  must 
confess,  however,  that  the  distinctive  characteristics  of  the  new  substance  do 
not  seem  to  me  very  decidedly  marked  in  the  results  announced  by  Dr.  Stark; 
and  such  is  the  complex,  and  often  deceptive  nature  of  the  investigations  of 
physiological  chemistry,  that  we  have  a  right  to  wait  for  renewed  experi- 
ments before  admitting  too  implicitly  the  certainty  of  those  he  has  described. 

Dr.  Stark  considers  that  his  experiments  entirely  subvert  an  opinion 
which  has  met  with  some  favour  regarding  the  theory  of  these  appearances. 
Ever  since  the  publication  of  Nauche's  paper,  the  supposed  presence  of  ca- 
seum  in  the  urine  of  pregnancy  has  countenanced  the  idea  entertained  by 
Bird  and  others,  already  referred  to,  that  the  elements  of  the  milk  (not  as 
Dr.  Stark  infers,  the  milk  itself,)  might  probably  exist  in  the  urine: — as, 
however,  the  matter  is  neither  milk  nor  caseum,  a  theory  based  upon  their 
presence  must  necessarily  fall.  The  conclusion  may  be  a  correct  one  so  far 
as  the  chemical  analysis  is  concerned;  and  yet  the  connection  between  the 
kiesteine  pellicle  and  the  mammary  secretion  may  be  adequately  proved  by 
other  evidence.  If  even  the  Gravidine  be  regarded  as  a  new  organic  prin- 
ciple, its  properties  are  not  so  peculiar,  nor  its  analogies  with  caseum  so 
remote,  as  necessarily  to  imply  the  operation  of  different  causes  in  the  form- 
ation of  the  two. 

I  have  already  mentioned  my  conviction,  founded  on  personal  observations, 
that  the  unmodified  caseum  is  not  found  in  the  urine;  but  the  presence  of 
the  colostral  appearances  under  the  microscope,  and  the  numerous  pheno- 
mena which  I  have  described  as  attending  the  presence  of  the  Kiesteine 
leave  me  no  room  to  doubt  its  intimate  connection  with  the  condition  of 
lactation. 


1842.]  G\hson^s  Case  of  Anchylosis  of  the  Knee-joint,  39 


Art.  II. — Case  of  complete  Anchylosis — in  lohich  the  Knee-joint  iv as  per- 
manently flexed — cured  by  an  operation.  By  Wm.  Gibson,  M.  D., 
Professor  of  Surgery  in  the  University  of  Pennsylvania.  Reported  by 
Thomas  L.  Walker,  M.  D.,  of  Albemarle,  Virginia,  one  of  the  resident 
Physicians  of  the  Philadelphia  Hospital.     [With  two  wood  cuts!] 

The  frequency  with  which  Anchylosis  succeeds  to  wounds,  and  inflam- 
mation otherwise  established  in  articulations,  will,  it  is  hoped,  render  a 
report  of  the  continued  success  of  an  operation,  devised  and  first  executed 
by  Dr.  J.  Rhea  Barton,  for  the  relief  of  this  misfortune,  interesting  to  the 
public.  I  would  not  be  understood  as  having  reference  to  the  less  serious 
variety — that  in  which  the  rigidity  is  confined  to  the  soft  parts,  in  which 
partial  mobility  of  the  joint  is  still  maintained,  and  to  accomplish  the  cure  of 
which,  such  simple  treatment  as  the  gentle  use  of  the  limb,  combined  with 
the  application  of  suitable  embrocations,  is  in  most  cases  alone  indicated.  I 
allude  exclusively  to  that  condition,  in  which  the  parts,  particularly  apper- 
taining to  the  structure  of  joints,  are  disorganized, — in  which  there  is  a  firm 
osseous  adhesion  between  the  ends  of  the  bones,  and  in  which,  since  the 
bones  are  so  consolidated  as  to  form  one  continuous  shaft,  there  is  perfect 
immobility  of  the  joint,  with  a  loss  of  all  of  its  functions  as  such. 

It  remained  for  the  inventive  genius  of  Dr.  Barton,  to  prove  to  the  pro- 
fession, the  fallacy  of  the  opinion,  that  this  was  an  irreparable  termination, 
and  that  it  should  be  regarded  rather  as  a  fortunate  result,  than  an  evil 
amenable  to  surgical  skill.  In  the  number  of  the  North  American  Medi- 
cal and  Surgical  Journal,  for  April,  1827,*  he  reported  his  first  operation, 
and  the  circumstances  suggesting  the  experiment.  It  was  performed  on  the 
person  of  a  sailor,  whose  hip-joint  was  perfectly  anchylosed,  and  the  limb 
so  situated,  as  to  overlap  the  unaffected  one.  In  this  case,  there  was  the 
twofold  indication  of  correcting  the  malposition  of  the  limb,  and  of  forming 
a  new  joint.  Accordingly,  the  thigh-bone  was  divided  (with  a  saw)  through 
the  great  trochanter,  and  a  part  of  its  neck.  This  being  done,  the  limb  was 
readily  straightened,  and  bony  union  having  been  prevented  by  daily  move- 
ment of  the  limb,  ligamentous  attachments  were  formed,  and  an  artificial  joint 
resulted.  After  the  lapse  of  sixty  days,  the  patient  stood  erect  upon  his  feet, 
with  both  heels  alike  touching  the  floor,  and  in  a  short  time,  possessed  per- 
fect use  of  the  new  joint. 

The  complete  success  of  this  operation,  encouraged  its  originator  to  ex- 
tend its  application;  believing  it  equally  adapted  to  the  relief  of  anchylosis 
of  other  joints,  as  that  of  the  knee,  shoulder,  elbow,  great  toe,  and  fingers. 
It  was  not  till  ten  years  had  passed,  however,  that  an  opportunity  presented 

*  See  also  Philad,  Journ.  of  Med.  and  Phys.  Sci.,  Vol.  XIV,  p.  177  and  416. 


40 


Gibson's  Case  of  Anchylosis  of  the  Knee-joint, 


[July 


itself  for  the  experiment.  An  intelligent  physician, — who  had  for  many 
years,  from  injury  upon  the  knee,  endured  the  inconvenience  of  anchylosis 
of  that  joint,  and  great  deviation  of  the  limb  from  its  proper  direction, — ap- 
plied to  Dr.  Barton  for  relief.  In  this  case,  an  operation  was  performed  for 
the  purpose  of  straightening  the  limb.  The  case  was  reported  in  detail  in 
the  No.  of  the  American  Journal  of  the  Medical  Sciences  for  Feb.  1838,  p. 
332.  It  will  now  only  be  alluded  to,  so  far  as  it  may  be  explained,  by  the 
details  of  a  recent  operation,  successfully  performed  by  Professor  Gibson. 
The  cases  are  almost  identical,  and  a  description  applicable  to  the  one,  is 
equally  true  of  the  other. 

Last  fall,  during  the  attendance  of  Dr.  Gibson  as  surgeon  to  the  Philadel- 
phia Hospital,  James  Johnson,  coloured,  setat  17,  was  admitted.  He,  two 
years  previously,  whilst  cutting  with  an  axe,  inflicted  upon  his  right  knee 
a  wound,  of  which  nothing  more  is  known  than  that  he  recovered  with  a 
loss  of  the  joint,  and  with  the  leg  flexed  backwards  toward  the  thigh.     In 

this  situation  he  entered  the  Hos- 
pital, the  leg  being  so  flexed 
as  to  form  an  angle  much  less 
than  a  right  angle  with  the  thigh. 
(See  accompanying  figure.)  He 
came  in  determined  to  submit  to 
an  operation,  and  expressed  great 
anxiety  that  it  should  be  per- 
formed. A  careful  examination 
satisfied  Dr.  Gibson,  that  the 
parts  belonging  to  the  joint  were 
all  destroyed: — ligaments,  carti- 
lages, and  the  synovial  mem- 
branes; and  that  it  was  a  case 
of  complete  anchylosis.  As  in 
the  patient  last  operated  upon  by  Dr.  Barton,  he  (Dr.  G.)  did  not  think  that 
circumstances  justified  his  attempting  the  double  indication  of  forming  a 
false  joint  and  extending  the  limb  too.  His  only  aim,  therefore,  was  to 
correct  its  malposition.  Accordingly,  everything  seeming  to  favour  the 
operation,  both  as  to  the  will  and  robust  health  of  the  patient,  and  the 
entire  concurrence  of  other  surgeons  consulted  by  Dr.  Gibson,  it  was  deter- 
mined on. 

Nov.  17th,  1841.— The  patient  having  been  for  several  days  restricted  in 
his  diet,  was  brought  forward,  prepared  for  the  operation.  Before  a  full 
attendance  of  medical  students,  and  many  eminent  physicians,  the  proposed 
operation  was  explained  by  Dr.  Gibson;  after  which,  he  proceeded  as  fol- 
lows:— Two  incisions  were  made,  as  in  the  operation  of  Dr.  Barton;  the 
first  extending  from  the  outer  to  the  inner  side  of  the  limb,  and  passing  im- 


1842.]  Gih&ou^s  Case  of  Anchylosis  of  the  Knee-joint,  41 

mediately  above  the  patella;  the  second  commencing  on  the  outer  side,  two 
and  a  half  inches  above  the  first,  and  meeting  it  at  an  acute  angle  on  the 
inner  side.  These  incisions  penetrated  to  the  bone,  engaging  the  integu- 
ments, the  tendon  of  the  extensor  muscles,  and  some  of  their  fibres.  The 
soft  parts  included  between  the  incisions  being  dissected  off  and  turned  back, 
the  bone  was  exposed  to  view.  A  portion  of  the  femur,  of  a  wedge  shape, 
was  then  removed  with  the  saw,  having  a  base  upwards  of  two  inches  and  a 
half  anteriorly,  and  reaching  to  within  a  few  lines  of  the  posterior  surface  of 
the  bone.  The  operation  was  then  concluded  by  inclining  the  leg  back- 
wards, which  caused  that  portion  of  the  bone's  diameter,  undivided  by  the 
saw,  readily  to  yield,  and  the  solution  of  continuity  to  be  made  complete. 
This  method  of  accomplishing  the  separation  of  the  bone,  was  regarded  as 
an  important  step  in  the  operation,  inasmuch  as  it  guarded  the  popliteal  artery 
against  wounds  from  the  saw;  and  the  dovetailed  edges  of  the  opposed  sur- 
faces were  influential  in  fixing  the  extremities  of  the  bones,  until  the 
asperities  of  these  surfaces  were  removed  by  absorption,  or  by  the  formation 
of  new  matter.  No  blood-vessels  were  divided  requiring  the  ligature  or  com- 
pression. The  operation  was  completed  in  a  few  minutes,  and  the  flap 
being  returned  to  its  place,  and  secured  by  the  interrupted  suture,  light 
dressings  were  applied.  The  patient,  lying  upon  his  back,  was  put  to  bed, 
with  the  limb  supported  upon  a  double  inclined  plane,  having  an  angle  cor- 
respondent to  that  of  the  knee,  before  the  operation.  As  great  care  was 
necessary  to  provide  against  pressure  upon  the  popliteal  vessels,  the  limb 
reposed  on  two  bran  bags,  which  were  fastened  to  the  edges  of  the  plane,  so 
fashioned,  that  its  angularity  could  be  varied,  without  being  removed  from 
beneath  the  leg,  as  its  extension  might  require.  The  vacancy  between  the 
bags  was  carefully  supplied  with  cotton.  Very  slight  hemorrhage  followed, 
which,  proceeding  from  the  division  of  one  of  the  articular  arteries,  stopped 
spontaneously  in  a  short  time;  and  except  for  a  slight  oozing,  which  con- 
tinued for  two  days,  there  was  no  sign  of  hemorrhage  afterwards. 

In  the  evening,  the  patient  suflTered  very  little  pain;  complaining  only  of  a 
slight  uneasiness  in  the  inguinal  region,  which  was  attributed  to  the  position 
of  the  limb;  was  indisposed  to  sleep,  consequently  took  fifty  drops  of 
laudanum. 

I8//1. — Passed  a  comfortable  night;  was  without  pain,  and  felt  perfectly 
easy;  oozing  from  knee  very  inconsiderable;  rigidity  of  muscles  diminished, 
and  leg  less  contracted. 

19^^. — Slept  all  night  without  pain.  Pulse  full,  strong,  and  regular  (about 
72  in  the  minute).  Leg  had,  by  force  of  gravitation,  extended  itself  a  good 
deal. 

20/^. — Enjoyed  undisturbed  sleep  throughout  the  night  without  any 
laudanum;  complains  of  slight  pain  opposite  the  lesion  of  the  bone;  no  fever; 
appetite  good;  bowels  opened  naturally.     The  dressings  removed  for  the 


42  Gibson's  Case  of  Anchylosis  of  the  Knee-joint,  [July 

first  time,  and  the  leg  allowed  to  extend  itself.  Measurement  proved  the 
height  of  the  angle  to  be  diminished  by  three-quarters  of  an  inch.  Simple 
dressings  applied  again. 

21 5/. — Continued  to  do  well.  No  fever  or  pain;  towards  evening,  slight 
uneasiness  endured,  from  the  stretching  of  the  tendons.  Extension  of  leg 
increased  by  full  another  inch. 

23(/. — Limb  was  approaching  the  extended  condition  fast.  No  fever.  In 
consequence  of  slight  pain  experienced,  patient  was  allowed  forty  drops  of 
laudanum. 

24^A. — Bowels  were  again  opened.  Passed  a  restless  night,  from  pain  in 
the  foot,  caused  by  the  heel's  accidentally  coming  in  contact  with  the  splint. 
Suppuration  commenced.     Laudanum  repeated. 

25/A. — Entirely  free  from  pain.  Bowels  again  opened.  No  fever.  The 
extension  of  the  leg  required  the  splint  to  be  let  out.  The  extension  pro- 
gressed so  rapidly,  that  a  pad  was  applied  to  the  sole  of  the  foot,  by  which 
resistance  was  opposed  to  the  direction  of  the  elongation  of  the  leg. 

26/^. — Wound  discharged  freely.  Pulse  a  little  accelerated.  Towards 
evening  the  knee  stripped,  and  newly  dressed.     Sutures  all  free. 

Dec.  5th. — Between  the  26th  of  Nov.  and  the  5th  of  Dec,  nothing 
transpired  worthy  of  being  mentioned.  The  patient  continued  uniformly  to 
improve,  the  limb  to  extend  itself,  and  his  general  health  such  as  to  require 
no  interference  on  the  part  of  the  surgeon.  On  the  5th,  the  straightening  of 
the  limb  was  sufficient  to  justify  the  removal  of  the  splint,  for  which  a  simple 
box  was  substituted.  This  was  carefully  lined  with  carded  cotton,  no  part 
of  the  leg  or  foot  being  suffered  to  rest  upon  the  wood.  The  comparative 
length  of  the  two  limbs  was  taken,  measuring  from  anterior  superior  process 
of  the  ilium  downwards.  As  far  as  an  accurate  measurement  was  obtained 
we  were  induced  to  give  the  sound  limb  an  excess  of  an  inch  and  a  half. 

lith. — Since  the  date  of  the  preceding  note,  the  patient's  condition  was 
very  favourable.  No  unpleasant  symptom  appeared.  The  wound  continued 
to  heal.  Suppuration  was  so  abundant  as  to  require  two  dressings  daily. 
Had  no  pain.  Slept  naturally.  Appetite  was  good,  and  digestive  functions 
perfect.  In  consequence  of  the  too  rapid  growth  of  granulations,  red  pre- 
cipitate ointment  was  applied  to  the  wound  of  integuments,  and  sponge  tent 
introduced  into  the  upper  incision,  to  favour  the  escape  of  pus.  Tumefac- 
tion of  the  knee  commenced.     Pulse  somewhat  excited. 

IQth. — Wound  improved  regularly  after  the  application  of  the  ointment. 
Tumefaction  of  knee  increased.  No  pain  endured.  The  secretion  of  pus 
was  so  copious,  that  an  opening  was  made  near  the  head  of  the  fibula, — 
which  situation  being  more  depending,  matter  to  the  amount  of  eight 
ounces  flowed  out.  Symptoms  of  debility  now  began  to  manifest  themselves. 
Pulse  was  quickened,  112.  Appetite  continued  good,  and  bowels  naturally 
soluble. 


1842.] 


Mettauer  on  Hypospadias  and  Epispadias. 


43 


23c?. — Progressive  improvement.  Except  the  irritation  symptomatic  of 
the  free  suppuration,  nothing  was  observed.  The  pulse  was  regularly 
excited,  though  the  patient  always  expressed  himself,  as  being  perfectly 
comfortable.     Tumefaction  of  knee  diminished. 

Jan,  5th,  1842. — From  the  23d  of  Dec.  to  this  time,  suppuration  con- 
tinued free.  The  orifice  made  with  the  lancet,  enlarged  itself  by  ulceration. 
Pulse  remained  quick,  but  general  appearance  improved.  In  consequence 
of  a  sinus  seeming  to  run  up  the  thigh,  a  seton  was  introduced  through  the 
opening  opposite  the  lesion  of  the  bone,  and  brought  out  two  inches  above. 

I2th.' — The  tape  withdrawn.  The  discharge  diminished.  The  bones 
were  found  to  be  firmly  united.  Patient  was  allowed  to  sit  up  with  the 
leg  supported  at  a  right  angle  with  his  body. 

26th. — Patient  was  able  to  walk  with 
the  assistance  of  crutches.  Wound  not 
entirely  healed. 

Feb.  Ibth. — Wound  every  where 
closed.  Could  bear  the  weight  of  his 
body  with  difficulty.  The  leg  shortened 
nearly  an  inch.  Walked  without  the 
enclosure,  assisted  by  crutches.  General 
health  perfect. 

May  1st. — For  the  last  two  months  the 
patient  has  walked  about  continually  with- 
out the  use  of  a  crutch  or  a  stick;  and  lat- 
terly has  been  twice  to  town  and  back  on 
foot, — having  walked  three  or  four  miles 
without  the  slightest  inconvenience.  The 
accompanying  figure  shows  the  present 
appearance  of  the  knee.  The  knee  at  this 
time  is  only  half  an  inch  shorter  than  the  other. 


Art.  IIL — Practical  observations  on  those  Malformations  of  the  Male 
Urethra  and  Penis,  termed  Hypospadias  and  Epispadias,  with  an  Jino- 
malous  Case.  By  John  P.  Mettauer,  M.  D,,  of  Prince  Edward 
County,  Virginia. 


The  great  importance  of  malformations  of  the  male  genital  organs,  and 
the  impression  that  a  void  exists  to  some  extent  relative  to  their  surgical 
treatment,  have  induced  us  to  draw  up  an  abstract  of  our  experience  in  the 
treatment  of  these  mortifying  and  disgusting  imperfections. 


44  Mettauer  on  Hypospadias  and  Epispadias.  [July 

The  malformations  to  which  we  shall  direct  attention  are  those  preter- 
natural openings,  or  fissures,  on  the  under  and  upper  surfaces  of  the  penis, 
termed  Hypospadias  and  Epispadias;  the  former  epithet  being  given  when 
the  openings  are  on  the  under  surface  of  the  penis,  and  the  latter  when  they 
are  on  the  superior  surface  of  that  organ. 

The  former  is  much  the  more  frequent  form  of  these  imperfections. 
These  openings  occur  in  the  median  line,  and  in  almost  every  point  between 
the  meatus  and  neck  of  the  bladder,  though  they  most  frequently  occur 
near  the  anterior  extremity  of  the  penis;  and  they  are  liable  to  every  possible 
variety  of  form  and  shape.  They  are  sometimes  round  and  exceedingly 
small,  and  transmit  the  urine  with  great  difficulty.  Occasionally  they  close 
up  and  prevent  the  escape  of  urine  altogether.  More  frequently,  however, 
they  are  large  and  vary  in  form  from  an  oval  to  a  fissure,  or  slit.  When 
of  an  oval  form,  their  margins  are  generally  labiated  and  more  or  less  thin. 
When  they  appear  under  the  form  of  a  fissure,  they  may  extend  nearly  or 
quite  the  whole  length  of  the  penis,  presenting  the  opening  very  much  as  if 
the  urethra  had  been  artificially  slit  open.  If  confined  to  the  glans  only, 
these  fissures  impart  a  most  singular  appearance  to  the  organ,  resembling  in 
some  degree  the  head  of  a  fish  laid  open  on  its  under  side.  Occasionally, 
the  last  named  malformation  is  complicated  with  a  permanent  flexure  of 
the  penis  at  its  cervix. 

In  many  cases,  the  urethra  is  entirely  deficient  from  the  preternatural 
orifice  quite  to  the  extremity  of  the  penis.  Now  and  then  the  organ  is 
greatly  shortened,  or  preternaturally  lengthened  and  thickened,  with  a  cor- 
responding dilatation  of  the  urethra  into  a  pouch,  as  complications  of  the 
infirmity.  And,  finally,  epispadias  occasionally  is  to  be  met  with  as  a 
complication  of  hypospadias,  and  then  the  urine  as  it  passes  from  the  blad- 
der, flows  from  both  surfaces  of  the  organ  at  the  same  time  forming  two 
distinct  streams.  When  this  complication  displays  the  glans  open  its 
whole  length,  an  appearance  not  very  unlike  a  turtle's  head  is  presented.  Oc- 
casionally, though  rarely,  the  cleft  in  this  complication  occupies  the  whole  of 
the  penis,  from  the  extremity  of  the  glans  to  the  arch  of  the  pubes. 

Epispadias  is  of  rare  occurrence,  but  when  met  with  presents  appearances 
of  the  openings  very  similar  to  those  already  described  under  the  head  of 
hypospadias. 

In  both  forms  of  the  malformation,  the  urethra  may  terminate  without 
an  external  opening  for  the  escape  of  urine;  and  in  early  infancy,  such  a 
modification  of  it  occasionally  occurs,  as  the  cause  of  those  distressing  ex- 
amples of  infantile  retention  of  urine,  from  which  such  terrible  consequences 
have  been  known  to  follow  at  that  tender  period  of  life.  Every  form  and 
variety  of  these  imperfections,  is  distinguished  by  a  greater  or  less  deficiency 
of  the  prepuce;  and  sometimes,  too,  it  is  either  entirely  absent,  or  preter- 
naturally superabundant. 


1 842.]  Mettauer  on  Hypospadias  and  Epispadias,  45 

These  malformations  are  almost  always  congenital,  and  must,  when  this  is 
the  case,  be  referred  to  arrest  of  development.  Occasionally  they  have  been 
produced  by  accidents,  and  by  artificial  means.  Abscesses  along  the  rapheal 
line,  have  resulted  in  a  species  of  hypospadias,  when  the  openings  formed  by 
art,  or  spontaneously  for  the  evacuation  of  matter,  have  remained  unhealed. 
Laceration  of  the  urethra  has,  likewise,  produced  something  of  the  same 
kind,  when  it  has  occurred  along  the  rapheal  line,  and  has  been  followed  by 
sloughing  of  the  parts. 

The  operation  of  puncturing  the  bladder  in  retention  of  urine,  has  also 
produced  a  form  of  this  malformation,  especially  when  the  urethra  instead 
of  the  bladder  has  been  penetrated.  These  examples,  however,  should  be 
regarded  rather  as  fistulous  openings  from  accidental  causes,  than  instances 
of  hypospadias.  The  case  of  the  unfortunate  shepherd  cited  by  M.  Riche- 
rand  in  his  physiology,  is  the  only  one  known  to  us  produced  by  design; 
and  is  remarkable  for  the  great  extent  of  the  fissure, — which  it  is  stated  ex- 
tended from  the  extremity  of  the  glans  nearly  or  quite  to  the  arch  of  the 
pubes;  and,  for  the  complete  separation  of  the  corpora  cavernosa  on  both 
surfaces  of  the  penis,  so  as  to  impart  to  it  the  appearance  of  two  distinct 
organs.  In  this  case  the  corpora  cavernosas  were  gradually  separated  by  the 
shepherd's  own  hand,  aided  at  different  times  by  the  use  of  certain  instru- 
ments, to  increase  the  irritation  which  became  necessary  to  elicit  emission; 
and  each  corpus  cavernosum  possessed  the  erectile  power. 

Every  variety  of  these  malformations  exposes  their  subjects  to  more  or 
less  inconvenience  in  urinating;  and  sometimes  individuals  suffer  great  pain 
and  anxiety,  especially  when  the  orifices  are  small,  or  when  they  become 
obstructed,  or  close  up,  as  will  occasionally  be  the  case.  The  parts  conti- 
guous to  such  openings  are  liable  to  excoriate,  and  to  become  exceedingly 
tender  and  irritable,  so  as  to  occasion  much  distress  during  urination.  But, 
generally,  they  become  most  annoying  on  account  of  the  mortifying  defor- 
mity they  produce,  and  from  the  impediments  they  too  frequently  oppose  to 
sexual  intercourse,  and  more  especially  to  matrimony.  Occasionally,  too, 
the  mental  depression  which  always  accompanies  these  imperfections,  se- 
riously impairs  the  corporeal  health;  and  in  some  instances  it  has  resulted 
in  epilepsy;*  and  a  wasting  melancholy,  and  even  in  confirmed  mental  de- 
rangement. Sometimes  the  local  irritation  connected  with  these  malforma- 
tions, seriously  impairs  the  constitutional  health,  by  first  inducing  seminal 
weakness,  or  losses;  and  thereby  producing  indigestion;  irregular  bowels; 
loss  of  appetite;  fever;  debility;  emaciation;  disturbed  rest;  an  endless 
variety  of  nervous  symptoms;  and,  extreme  susceptibility  to  colds,  or  to  be 
morbidly  impressed  by  vicissitudes  of  atmospheric  temperature. 

*  A  case  of  the  kind  passed  under  our  care,  was  of  many  years  standing,  and  yielded, 
finally,  after  the  employment  of  a  great  variety  of  remedies,  to  the  crusta  genu  equina,  a 
most  valuable  therapeutic  agent  in  such  affections. 


46  Mettauer  on  Hypospadias  and  Epispadias,  U^^V 

Treatment. — Many,  nay  we  believe  all,  of  these  malformations  may  be 
corrected,  or  greatly  relieved  by  proper  treatment,  although  they  have  in  nu- 
merous instances  been  regarded  as  irremediable.  Hypospadias  of  the  more 
simple  form,  or  when  the  opening  is  situated  only  a  short  distance  from  the 
extremity  of  the  glans,  and  the  urethra  between  those  points  is  either  defi- 
cient, or  if  present  too  contracted  to  allow  urine  to  pass,  requires  an  exceed- 
ingly simple  and  easy  treatment.  Introducing  a  small  trocar  about  the  size 
of  the  natural  passage  from  the  opening,  along  the  tract  usually  pursued  by 
the  urethra,  quite  through  the  extremity  of  the  glans,  will  eflectually  open 
the  passage.  Care  should  be  taken,  however,  during  the  operation,  that  the 
instrument  shall  not  cut  through  the  thin  rapheal  wall,  especially  in  the 
glans;  and  to  prevent  such  an  accident,  the  cutting  edges  of  the  trocar  should 
be  directed  to  the  sides  of  the  penis,  and  along  the  angle  between  the  cor- 
pora cavernosa.  Firmly  supporting  the  penis  by  grasping  it  with  the  left 
hand,  and  flexing  it  at  the  same  time  at  the 'opening,  so  as  to  enable  the 
operator  to  enter  the  trocar  accurately  from  the  termination  of  the  urethra, 
little  difficulty  will  be  experienced  in  giving  a  proper  direction  to,  and  in 
passing  the  instrument  out  through  the  extremity  of  the  glans.  As  soon  as 
the  passage  is  opened,  a  gum  elastic  tube  of  proper  size  and  length  should  be 
introduced  quite  through  it,  and  at  least  eight  or  ten  lines  beyond  it  into  the 
urethra.  The  tube  should  fill  the  newly  formed  passage  completely,  and 
must  be  cut  off  at  its  entering  extremity,  and  rounded  off  so  as  to  enter 
"without  wounding  the  parts:  it  must  also  be  headed  at  its  outward  extremity 
with  sealing  wax.  By  filling  the  passage  completely  its  introduction  will 
arrest  the  hemorrhage  at  once;  and  there  will  be  less  danger  of  the  displace- 
ment of  a  tube  fitting  the  passage  tighUy.  Where  fairly  introduced,  the  tube 
may  be  securely  confined,  by  connecting  its  head  to  a  kind  of  hood  which 
firmly  embraces  the  penis,  with  threads,  or  very  narrow  tapes.  Thus  ad- 
justed it  serves  to  give  passage  to  the  urine  during  urination,  and  to  maintain 
the  newly  formed  urethra  well  dilated,  and  of  proper  size,  until  it  inflames  and 
suppurates  sufficiently  to  prevent  urinal  infiltration  into  the  surrounding  tex- 
tures. Generally  the  tube  should  remain  in  the  passage  two  or  three  days, 
or  until  free  suppuration  is  established.  After  this  it  may  be  dispensed  with, 
and  a  short  bougie  of  proper  size  introduced  in  its  stead,  for  half  an  hour  at 
a  time,  three  or  four  times  daily,  until  the  passage  ceases  to  matter;  it  should 
then  be  introduced  once  or  twice  daily  for  several  months,  or,  until  the  pas- 
sage is  firmly  established.  Occasionally,  a  catheter  carried  freely  into  the 
bladder  may  be  employed  instead  of  the  short  tube,  for  the  purpose  of  dilat- 
ing the  newly  formed  passage;  and  when  there  is  reason  to  believe  that  the 
corpora  cavernosa,  or  the  corpus  spongiosum  are  wounded,  it  should  inva- 
riably be  preferred;  it  answers  admirably  for  restraining  hemorrhage,  and 
preventing  accidental  infiltrations  of  urine  into  the  surrounding  textures. 
When  the  catheter  is  employed,  it  should  be  secured  in  the  passage  as 


1842.]  Mettauer  on  Hypospadias  and  Epispadias.  47 

already  advised  with  respect  to  the  short  tube;  and  must  be  guarded  with  a 
stopper,  to  prevent  involuntary  discharges  of  urine  from  the  bladder. 

If  the  parts  inflame  much,  as  will  sometimes  be  the  case,  they  should  be 
freely  bathed  with  cold  water;  cold  elm-tea;  cool  saturnine  lotions;  or,  warm 
fomentations  may  be  used,  if  found  more  agreeable.  Occasionally,  cataplasms 
will  be  required  to  allay  the  irritation;  and  they  should  invariably  consist  of 
bland  mucilaginous  or  farinaceous  substances.  The  bowels  should  be  opened 
freely  from  time  to  time.  Rest  will  be  highly  beneficial,  not  only  in  ena- 
bling the  surgeon  to  maintain  the  proper  adjustment  of  the  dilating  means, 
but,  also,  in  guarding  against,  and  in  correcting  the  traumatic  inflammation. 
Patients,  generally,  should  be  confined  in  bed,  and  undressed,  for  at  least 
five  or  six  days  after  the  operation,  and  even  longer,  if  there  is  much  in- 
flammation and  an  antiphlogistic  diet  directed. 

The  fistulous  openings  may  be  touched  with  nitras  argenti  and  the  slough 
scraped  off"  with  a  knife,  before  the  passage  is  restored,  or  afterwards.*  We 
have  adopted  both  methods,  but  think  it  best  to  employ  the  former,  as  the 
surgeon  is  then  enabled  to  accomplish  an  immediate  cure.  The  denudation 
must  be  efl;*ectually  performed,  and  may  be  done  by  scraping  ofl"  the  dark 
eschar  with  a  small  scalpel.  The  surfaces  thus  denuded  readily  unite  as  a 
fresh  cut;  or  by  granulations  which  amalgamating  efl'ectually  close  the  ori- 
fice. Sometimes  it  will  be  necessary  to  apply  the  caustic  repeatedly  before 
the  cure  is  effected.  And  occasionally  it  will  be  required  to  approximate  the 
margins  of  the  opening,  either  with  adhesive  plasters,  or  a  bandage,  to  ena- 
ble us  to  effect  its  obliteration.  These  openings  should  never  be  denuded  by 
excising  their  margins,  as  too  great  a  loss  of  substance  would  then  be  the 
consequence.  In  all  the  examples  of  this  form  of  hypospadias,  the  plan  of 
treatment  which  we  have  briefly  described,  will  be  found  to  answer  per- 
fectly. The  same  principles  of  treatment  should  guide  us  in  cases  in  which 
the  opening  is  low  down  on  the  penis,  or  in  the  perineum;  in  these  last  how- 
ever a  longer  trocar  will  be  required  to  form  the  passage,  as  well  as  longer 
tubes  or  bougies  to  maintain  it  dilated.  The  catheters  for  this  purpose 
should  be  long  enough  to  enter  the  bladder;  and  they  must  fill  the  passage 
tightly  for  the  double  purpose  of  rendering  it  free,  and  to  put  an  immediate 
stop  to  the  traumatic  bleeding  which  is  sometimes  very  profuse.  After  free 
suppuration  is  established — which  will  be  the  case  in  three  or  four  days, 
and  sometimes  earlier — the  tube  may  be  removed.  It  should  never  be  left 
out  oi  the  passage,  however,  long  at  a  time  for  several  days;  and  must  inva- 


*  This  mode  of  denudation  is  peculiar  to  us,  and  has  been  almost  daily  in  use  in  our 
practice  for  twelve  years.  It  will  be  found  very  convenient  in  deep  and  inaccessible 
locations  where  cutting^  instruments  cannot  be  effectually  employed:  and  is  as  effectual 
as  the  mode  by  excision,  if  not  more  so.  Union  may  be  effected  through  it  either  by  the 
first  or  second  intention. 


48  Mettauer  on  Hypospadias  and  Epispadias.  [J"ly 

riably  be  replaced  before  urination,  to  prevent  the  painful  scalding  which 
would  certainly  follow,  as  well  as  to  guard  against  the  possibihty  of  infil- 
tration of  urine. 

The  directions  already  given  in  relation  to  the  mode  of  retaining  the  tube 
securely  in  the  bladder  and  passage,  and  for  guarding  against  involuntary 
discharges  of  urine  with  a  stopper,  must  govern  in  the  cases  now  under  ex- 
amination. After  a  week  from  the  operation,  patients  may  be  allowed  to 
urinate  without  the  use  of  the  tube;  and  for  the  purposes  of  dilating  the  pas- 
sage after  this  period,  either  tubes  or  bougies  may  be  employed:  these  in- 
struments must  be  used  once  or  twice  daily,  for  months  after  the  operation. 

The  closure  of  the  orifices  in  these  examples  of  hypospadias  will  require 
a  plan  somewhat  different  from  that  already  considered.  Being  generally 
of  large  size,  and  situated  in  a  part  of  the  organ  abounding  in  loose  textures, 
their  margins  may  be  readily  and  rapidly  denuded  by  excision;  and  this 
mode  we  have  uniformly  adopted,  unless  there  should  be  a  deficiency  of 
substance.  The  margins  may  be  pared  off  with  a  keen  delicate  knife;  and 
this  operation  should  be  effectually  done.  As  soon  as  accomplished,  the 
denuded  surfaces  must  be  accurately  brought  together  and  confined  in  close 
contact,  either  with  adhesive  plasters  or  the  uniting  bandage;  or,  by  the 
introduction  of  one  or  more  points  of  the  interrupted  suture;  and  these  steps 
should  always  immediately  succeed  the  introduction  of  the  tube  after  the 
formation  of  the  new  passage,  for  the  reasons  already  urged.  In  some 
cases,  however,  the  nitras  argenti  may  be  depended  on  exclusively,  or  be 
employed  as  an  auxiliary  where  the  surfaces  denuded  by  incision  fail  to  close 
up  the  openings  completely.  The  actual  cautery  we  have  never  used  in 
these  malformations,  nor  are  we  inclined  to  recommend  so  terrific  a  mea- 
sure, especially  when  children  are  the  subjects  to  be  treated.  When  the 
malformation  is  distinguished  by  an  open  cleft  or  fissure,  from  the  termina- 
tion of  the  urethra,  quite  to  the  extremity  of  the  glans,  or  nearly  so,  modi- 
fications by  no  means  uncommon,  the  margins  must  be  carefully  denuded 
with  a  knife;  or,  by  touching  them  with  nitras  argenti,  and  then  carefully 
scraping  off  the  eschars  until  they  are  perfectly  denuded.  The  passage 
corresponding  with  the  tract  of  the  urethra  must  then  be  filled  with  a  tube 
or  catheter  of  proper  size,  and  the  denuded  margins  be  brought  together  so 
as  to  embrace  it,  and  at  the  same  time  to  be  in  exact  and  close  contact 
throughout  their  whole  extent.  In  this  condition  they  are  to  be  retained, 
and  securely  fixed  with  court-plaster  applied  in  successive  narrow  strips 
around  the  organ  the  whole  extent  of  the  fissure.  Thus  adjusted,  the  whole 
must  be  confined  by  a  narrow  soft  bandage  applied  so  as  to  act  upon  every 
part  of  the  organ  requiring  support,  and  some  distance  below,  the  more 
effectually  to  prevent  displacement.  In  the  application  of  the  bandage  no 
more  force  should  be  employed  than  is  sufficient  to  support  the  under  dress- 
ing, and  to  maintain  the  apposition  of  the  denuded  margins  perfect.     If  ap- 


!842.]  Mettauer  on  Hypospadias  and  Epispadias.  49 

plied  very  tightly,  great  distress  and  excoriation,  or  even  sloughing  may 
follow. 

The  tube  must  now  be  carefully  connected  with  the  bandage  by  threads 
or  narrow  tapes,  and  guarded  with  a  stopper.  In  most  of  these  cases,  too, 
the  tube  should  extend  quite  into  the  bladder;  as  by  that  arrangement  it 
would  be  less  liable  to  accidental  displacement,  and  more  effectually  at  the 
same  time  prevent  the  escape  of  urine  along  the  urethra.  It  must  be  kept 
in  until  free  suppuration  is  established,  which  will  generally  be  in  from  three 
to  four  days.  Generally,  the  tube  should  not  be  removed  sooner  than  the 
fourth  day;  and  if  no  inconvenience  attend,  it  may  be  allowed  to  remain  in 
until  the  fifth  or  even  the  seventh  day  after  the  operation.  When  removed 
the  tube  should  be  drawn  out  very  gently  and  gradually,  so  as  not  to  disturb 
the  lips  of  the  recently  united  parts. 

After  the  tube  is  withdrawn,  the  meatus  may  be  gently  washed  with  tepid 
or  cold  water,  should  the  parts  require  it.  The  tube  may  be  replaced  after 
a  few  moments,  and  kept  in  for  one  day  more.  If  union  of  the  lips  takes 
place  early,  the  bandage  may  be  removed  for  the  first  time  on  the  third  or 
fourth  day;  but  generally  it  will  be  most  safe  to  suffer  it  to  continue  on  until 
after  the  removal  of  the  tube  the  first  time.  The  plasters,  if  they  adhere, 
should  not  be  disturbed  during  the  whole  treatment.  If  they  loosen,  new 
ones  must  be  put  on.  The  plasters  and  bandages  must  be  continued  until 
firm  union  takes  place,  and  reapplied  daily  if  necessary.  As  soon  as  there 
is  good  reason  to  believe  that  pretty  firm  union  has  taken  place,  the  tube 
may  be  dispensed  with  in  some  measure;  but  it  should  be  introduced  once 
or  twice  daily,  as  long  as  matter  escapes  from  the  meatus,  for  a  few  mo- 
ments at  a  time,  to  prevent  any  narrowing  of  the  passage. 

This  form  of  hypospadias  fortunately  does  not  often  present  the  fissure  of 
very  great  extent;  and  being  confined  almost  exclusively  to  the  glans,  cer- 
vix, and  a  small  part  of  the  penis  beyond  it,  comparatively  little  diflficulty 
will  be  experienced  in  its  treatment  in  a  large  majority  of  cases;  and  the  plan 
which  has  been  premised  will  generally  be  found  to  meet  every  indication. 
When  it  involves  the  penis  behind  the  glans  to  any  considerable  extent,  the 
interrupted  suture  should  be  employed  to  close  the  fissure  after  its  margins 
have  been  well  denuded  by  excision  of  their  epithelium.     The  points  of  the 
suture  must  invariably  be  inserted  fully  three  lines  from  the  margins,  if  not 
more,  and  in  sufficient  number,  and  near  enough  together  to  approximate 
them,  and  to  close  the  fissure  perfecdy.     Over  the  sutures  narrow  strips  of 
court-plaster  should  be  placed  in  succession,  and  nearly  to  encircle  the  penis; 
the  whole  to  be  supported  by  a  narrow,  soft  bandage.     In  this  form  of  the 
imperfection,  a  long  tube  or  catheter  should  always  be  employed  as  the 
means  of  maintaining  the  passage;  and  should  be  introduced  quite  into  the 
bladder  before  the  sutures  are  applied;  over  which,  as  it  is  placed  along  the 
passage,  the  margins  of  the  fissure  can  be  readily  brought  in  contact,  and  - 
coaptated.     The  after  treatment  must  be  governed  by  the  directions  already 
No.  VII.— July,  1842.  5 


50  Mettauer  on  Hypospadias  and  Epispadias,  [July 

given.  It  may  be  remarked,  however,  that  the  adhesive  plasters  should  be 
allowed  to  remain  on  as  long  as  they  adhere;  and  when  to  be  removed,  they 
must  be  carefully  moistened  with  a  soft  wet  sponge  saturated  with  warm 
water,  applied  to  them  for  a  few  moments,  and  then  taken  off  with  delicate 
forceps,  loosening  the  extremities  first  so  as  to  peel  them  alternately  from 
each  extremity  to  the  line  of  union.  This  material,  it  may  be  remarked 
here,  is  the  very  best  for  all  delicate  operations  requiring  adhesive  plasters; 
and  our  commendation  of  it  is  based  upon  ample  experience  during  the  last 
twenty-five  years  in  numerous  and  satisfactory  trials. 

The  treatment  of  epispadias  should  be  directed  by  the  preceptis  which 
have  been  presented  in  regard  to  the  several  modifications  of  hypospadias. 
Generally,  it  will  be  much  easier  to  manage  the  former  than  the  latter  mal- 
formations, even  if  they  consist  of  a  mere  opening  or  fissure,  by  reason  of 
the  greater  width  of  their  margins,  which  afl?brds  more  surface  for  a  ready 
and  firm  union  of  them.  Complete  cures  can  generally  be  effected  in  these 
malformations  in  two  or  three  weeks. 

When  the  malformation  is  compounded  of  both  hypospadias  and  epispa- 
dias, as  in  the  case  of  the  shepherd  already  referred  to,  and  that  adverted  to  by 
Mr.  Liston,  it  will  be  necessary  to  denude  the  opposing  surfaces  their  whole 
extent,  either,  by  paring  off"  their  epithelium  with  a  scalpel;  or,  by  first  cau- 
terizing them  with  nitras  argenti,  and  then  scraping  oft'  the  dark  eschar.  A 
tube  of  proper  size  may  now  be  interposed  between  them  extending  fairly 
into  the  bladder,  and  placed  along  the  fissure,  so  as  to  form  a  passage  in  the 
angle  between  the  two  corpora  cavernosas  on  their  under  surfaces  where  they 
are  approximated.  The  two  columns  are  now  to  be  placed  in  exact  contact 
throughout  their  v^'hole  extent.  Thus  arranged,  they  must  be  confined  with 
a  sufficient  number  of  points  of  the  interrupted  suture  introduced  first,  along 
the  dorsal  fissure,  and  then  aloug  the  under  surface  of  the  organ,  to  maintain 
a  perfect  juxtaposition  of  the  denuded  surfaces:  here  the  sutures  should  not 
include  much,  if  any  of  the  elastic  ligament,  but  extend  only  a  sufficient 
depth  into  the  skin,  to  enable  them  to  confine  the  parts  firmly.  Over  the 
sutures  narrow  strips  of  court-plaster  should  be  applied  in  succession,  and 
long  enough  to  encircle  the  organ  completely;  and  the  whole  to  be  supported 
by  a  soft  narrow  bandage.  Great  care  will  be  required  in  the  coaptation  of 
the  parts,  so  as  to  enable  them  to  unite  perfectly,  and  to  give  to  the  penis  a 
natural  form,  especially  about  the  glans.  It  will  also  be  necessary  to  be 
particular,  in  placing  the  tube  properly  along  the  tract  in  which  the  urethra 
is  to  be  formed.  Simply  compressing  the  sides  of  the  organ  with  the  fingers 
until  the  tube  presents  fairly  on  the  under  surface  of  the  penis,  will  enable 
the  surgeon  to  give  it  the  proper  position;  and  this  should  be  done  after  the 
bandage  is  applied. 

The  tube  employed  in  this  operation  must  be  headed  with  sealing  wax, 
and  should  never  project  more  than  five  or  six  lines  beyond  the  extremity  of 
the  glans.     It  should  also  be  guarded  with  a  stopper,  and  securely  fixed  in 


1842.]  Mettauer  on  Hypospadias  and  epispadias.  51 

the  passage  by  making  it  perforate  the  cul  de  sac  of  a  hood  which  firmly  em- 
braces the  anterior  portion  of  the  penis.  Thus  adjusted,  the  dressings  must 
remain  four  or  five  entire  days.  If  the  traumatic  inflammation  becomes  vio- 
lent, cold  water  should  be  freely  applied,  either  by  using  compresses  or 
soft  sponges  saturated  with  cold  or  iced  water  to  the  dressings.  Generally, 
this  expedient  will  not  be  required,  as  the  inflammation  is  not  disposed  to 
become  excessive.  The  urine  should,  during  the  whole  treatment,  be  drawn 
off  after  short  intervals,  to  prevent  as  far  as  possible  the  danger  of  violent 
expulsive  efTorts  of  the  bladder  forcing  any  portion  of  that  fluid  around  the 
tube,  and  into  the  line  of  expected  union  of  the  corpora  cavernosa.  In  all 
other  respects  the  after  treatment  is  to  be  conducted  pretty  much  as  advised 
in  the  preceding  modifications  already  described;  and  the  cure  will  be  ac- 
complished in  two  or  three  weeks. 

Should  these  malformations  be  complicated  with  an  unsightly  and  incon- 
venierit  curvature  at  the  cervix,  or  any  other  portion  of  the  penis,  the  con- 
tracted part  must  be  divided  by  subcutaneous  incisions  in  succession,  until 
the  organ  is  liberated.  The  contracted  structures  can  be  easily  distinguished, 
and  readily  divided.  They  are  generally  situated  in  the  subcutaneous  cel- 
lular texture,  which  from  some  cause  has  lost  its  soft  and  yielding  qualities, 
and,  as  in  cases  of  burns,  refuses  to  elongate  with  the  development  of  the 
contiguous  textures,  and  in  that  way  may  produce  the  curvatures  in  question. 
Occasionally,  however,  the  deformity  depends  on  a  preternatural  shortening 
of  the  elastic  Ligament.  In  either  case  the  deformity  may  be  readily  cor- 
rected by  division  of  the  contracted  textures,  taking  care,  however,  to  em- 
ploy an  exceedingly  delicate  instrument  in  the  operation.  After  the  con- 
traction is  removed  the  organ  may  be  kept  perfectly  straight,  either  by  using 
a  short  tube  introduced,  as  already  suggested,  below  the  division,  until  the 
parts  heal;  or,  by  employing  at  the  same  time  delicate  splints  on  the  four 
surfaces  of  the  penis,  confined  by  a  bandage  as  already  advised.  When  the 
eontraetion  is  slight  the  tube  properly  confined  with  a  soft  bandage  will  efl^ee- 
tually  relieve  the  deformity.  In  bad  cases,  it  will  always  be  most  advisable 
to  employ  the  tube  and  splints  conjointly.  In  a  few  days  the  parts  heal 
|9€rfectly. 

Malformations,  when  complicated  with  extensive  dilatations  and  elonga- 
tions of  the  urethra  and  penis,  and  the  organ  in  those  parts  incapable  of  an 
-erectile  movement,  present  most  unsighdy  as  well  as  unfortunate  deformi- 
ties. Such  modifications,  unless  corrected,  completely  preclude  all  sexual 
^itercour^e,  as  the  organ  by  reason  of  its  permanent  flaccidity  and  nonerectile 
condition  must  be  utterly  incapable  of  penetrating  into  the  vagina,  even 
should  that  passage  be  free  from  all  obstruction  at  its  orifice.  An  exceed- 
ingly interesting  case  of  this  kind  having  recently  passed  under  our  care  and 
been  managed  successfully  we  shall  give  a  detailed  account  of  its  history, 
and  treatment,  as  likely  to  fyrnish  the  best  commeijtary  upon  such  forms  of 
hypospadias. 


52  Mettauer  on  Hypospadias  and  Epispadias,  U^^f 

Mr. ,  aetat  about  19  years,  of  moderate  statUre,  good  general  health, 

though  suffering  much  from  depression  of 
mind,  and  exceedingly  gloomy  from  the  pain- 
ful consciousness  of  his  mortifying  deformity^ 
was  placed  under  our  care  early  last  autumn^ 
This  penis  (see  fig.  1)  was  greatly  elongated, 
measuring  fully  eight  inches  from  the  scrotum 
to  the  extremity  of  the  glans  in  the  nonerect- 
ed  state.  The  anterior  three-fifths  (e,  d,  c)  une- 
qually dilated  in  its  lateral  dimensions,  with  a 
^1  \^  remarkable  expansion  of  the  corresponding 
portion  of  the  urethra,  and  perfectly  flaccid, 
and  nonerectile:  the  transverse  diameter  of  this 
portion  of  the  organ  when  largest  was  fifteen 
^^  iines^^,   from   which    part    it   tapered   to    the 

glans,  as  well  as  to  the  pubic  portion.  The  urethra  of  this  part  of  the  organ 
was  capable  of  containing  fully  tv/o  ounces  of  fluid;  and  the  cavity  was 
bounded  anteriorly  by  the  concave  glans;  posteriorly  by  the  rough  granular 
surface  of  the  pubic  two-fifths,  or  stump  of  the  organ;  and  laterally  by  walls 
formed  of  the  urethra  greatly  dilated,  the  elastic  ligament  and  integuments* 
The  pubic  portion  which  we  have  denominated  the  stump  {e,f,  g)  constituted 
about  two-fifths  of  the  penis,  was  well  formed,  capable  of  erectile  move- 
ment, and  terminated  abruptly,  so  as  to  form  the  pubic  extremity  of  the 
cavity  already  described,  with  the  orifice  of  the  urethra  projecting  from  its 
surface  so  as  to  form  a  kind  of  os  tincae  looking  into  that  cavity.  Low  down 
in  the  perinseum,  about  ten  lines  anterior  to  the  verge  of  the  anus,  and  in  the 
rapheal  line,  there  existed  an  extremely  elliptical  orifice  about  four  Ihies  in 
extent,  and  bounded  on  its  margins  by  a  kind  of  labiated  reduplication  of  the 
integuments,  resembling  in  some  degree  the  labia  pudendi  of  females,  through 
which  the  greater  part  of  the  urine  escaped.  The  urethra  about  eight  lines 
in  extent  anterior  to  this  orifice  was  nearly  impervious,  and  transmitted  only  a 
few  drops  of  urine  during  urination.  On  the  central  part  of  the  expanded 
portion  of  the  urethra,  which  we  have  termed  the  pouch,  and  in  the  rapheal 
line,  an  opening  existed  at  the  time  we  examined  into  the  case,  which  had 
been  formed  artificially,  but  had  become  completely  fistulous,  of  an  oval 
form,  and  four  lines  in  length,  through  which  a  few  drops  of  uiine  would 
occasionally  appear.  From  the  meatus,  a  mueo-purulent  discharge  frequently 
escaped,  especially  when  the  urine  was  forced  to  take  that  direction  by  par- 
tially closing  the  perinseal  opening  with  the  end  of  the  finger. 

With  the  deformity  Ave  have  attempted  to  describe,  strong  sexual  desires 
were  associated.  The  testes  were  perfectly  formed  and  of  large  size.  Our 
examination  induced  to  an  encouraging  opinion  as  to  the  practicability  of 
correcting  the  deformity;  so  far,  at  least,  as  to  place  the  organ  in  a  condition 
favourable  for  sexual  intercourse;  and  such  unexpected  good  tidings  to  the 


1842.]  Mettauer  on  Hypospadias  and  Epispadias.  53 

young'  man,  borne  down  by  melancholy  and  unhappy  afflictions,  caused  a 
lively  expression  of  joy  and  happiness;  and  he  at  once  formed  the  philoso- 
phic determination  to  submit  to  any  operation  we  might  think  proper  to 
undertake  for  his  relief.  In  a  few  days  the  following  plan  was  adopted; 
and,  as  the  sequel  will  show,  it  resulted  in  the  perfect  correction  of  the  mal- 
formation. 

The  patient  being  placed  in  a  strong  light  resting  upon  a  bed  of  conve- 
nient height,  and  on  his  back,  our  first  aim  was  to  transplant  the  glans  upon 
the  erectile  stump.  To  accomplish  this,  we  laid  open  the  pouch  its  whole 
extent   by  making    an    incision    along   the   rapheal  pj„  2. 

line.  We  next  removed  a  bell  from  the  interior  of 
the  cavity  seven  lines  in  width  entirely  around  the 
base  of  the  glans,  and  quite  to  that  organ,  so  as  to 
leave  that  part  of  the  wall  of  the  pouch  to  consist  ^^^, 
only  of  common  integuments  and  cellular  mem- 
brane. A  like  belt  was  removed  from  the  inferior 
portion  of  the  pouch,  quite  down  to  the  circum- 
ference of  the  face  of  the  erectile  stump.  We 
then  carefully  denuded  the  face  of  the  stump  in 
every  part  of  it.  After  the  blood  had  been  effectually  spunged  away  from 
the  new  surfaces,  the  glans  was  placed  with  great  care  upon  the  face  of  the 
stump,  taking  care  that  the  denuded  margin  at  its  base  should  correspond 
accurately  with  the  circumference  of  the  opposing  denuded  surface  of  the 
stump.  A  short  bougie  was  then  passed  into  the  meatus,  and  carried  along 
the  urethra  of  the  stump,  nearly  to  the  contracted  portion  of  it,  with  the 
design  of  enabling  us  to  retain  the  glans  more  easily  and  perfectly  in  its 
proper  position.  Thus  arranged  the  glans  was  firmly  connected  to  the  erec- 
tile stump  by  eight  points  of  the  glover's  suture,  applied  in  succession 
through  the  glans  and  stump  at  the  fraenum;  then  on  the  middle  of  the  dor- 
sum and  at  the  base  of  the  glans  through  these  portions  of  the  integuments 
immediately  contiguous  to  the  glans  and  stump;  next  on  each  side  through 
the  opposing  tegumentary  duplications  of  those  parts;  and  in  succession 
until  the  whole  series  was  completed.  Care  was  taken,  however,  in  the 
introduction  of  the  sutures  through  the  tegumentary  laminae,  that  ample 
space  between  them  was  allowed  for  the  free  passage  of  blood  to  the  glans. 
When  the  sutures  were  tightened  tliey  fixed  the  glans  most  perfectly  and 
securely  on  the  erectile  stump,  and  imparted  to  the  organ  thus  modified,  an 
improved  appearance  highly  gratifying. 

The  glans  thus  transferred  to  and  situated  upon  the  erectile  stump,  neces- 
sarily shortened  the  penis,  and  required  that  the  tegumentary  intermedium 
which  had  been  left,  should  be  inflected  upon  itself  so  as  to  form  a  loop-like 
body  on  the  dorsal  and  lateral  portions  of  the  organ  immediately  behind  the 
base  of  the  glans.  (Fig.  2,  b,  a,  c— /,  d,  e,  the  orifice  opening  into  the  cavity 
of  the  intermedium.)    This  loop-like  body  was  unavoidable,  inasmuch  as  the 

5* 


54  Mettauer  on  Bypospaclias  and  Epispadias.  [July 

glans  could  not  possibly  have  been  supplied  with  a  sufficiency  of  blood  for 
its  nutrition  and  support,  had  the  intermedittm  been  cut  away  at  once.  It 
was  large  and  exceedingly  inconvenient  as  it  now  existed,  and  would  have 
interfered  with  the  dressing  whieh  we  designed  using  at  this  stage  of  the 
operation.  To  remedy  these  inconveniences  in  son>e  degree,  we  removed 
about  one  half  of  the  band  of  which  it  was  formed,  talking  care  not  to  dis- 
turb the  sutures  during  the  operation;  and  as  the  section  was  effected  with 
scissors  little  pain  was  produced  by  its  excision.  We  found  it  necessary  tO' 
take  up  several  arteiies,  and  one  of  large  size  after  this  little  operation,  so 
profuse  and  annoying  was  the  flow  of  blood  from  them.  After  carefully 
spunging  away  the  blood  we  covered  the  margins  of  the  loop-like  body  with 
dry  lint,  then  put  on  a  few  very  narrow  strips  of  adhesive  plaster,  and  over 
them  a  narrow,  soft  bandage,  applied  in  such  a  manner  by  circular,  oblique, 
and  reverse  turns,  as  to  embrace  and  support  the  parts  with  tolerable  firm- 
ness. We  next  fixed  the  bougie  in  the  urethra  by  eonne"cting  threads  be- 
tween its  extremity  and  the  bandage. 

In  this  condition  the  parts  were  permitted  to  remain  until  the  third  day 
after  the  operation.  To  moderate  the  inflammation  cokl  water  was  applied 
freely  after  the  parts  began  to  swell,  and  continued  until  free  suppuration 
was  established  in  all  the  incisions.  Little  inflammation  followed  the  ope- 
ration, and  by  the  third  day  free  suppuration  was  established  throughout  alt 
of  the  ununited  cut  and  denuded  parts.  The  constitutional  fever,  too,  was 
very  slight. 

On  the  third  day  the  dressing  was  removed,  and  the  parts  about  the  con- 
nection of  the  glans  and  stump  appeared  to  have  united  perfectly.  After 
carefully  washing  the  wounds  they  were  redressed  as  in  the  first  instance, 
only  the  bougie  was  omitted.  In  this  manner  the  dressings  were  renewed 
daily  until  the  eighth  day,  when  three  of  the  sutures  were  cut  away  from 
the  under  part  of  the  penis.  After  this  a  very  light  dressing  was  employed;, 
and  the  remaining  sutures  wei-e  removed  daily  until  all  were  taken  away. 
The  union,  as  soon  as  it  was  deemed  safe  to  examine  the  parts  carefully,, 
which  was  on  the  twelfth  day  after  the  operation,  was  found  perfect  and 
firm.  The  margins  of  the  intermedium  did  not  heal  over  until  the  twentieth 
day;  and  fully  three  months  ela{)sed  from  the  date  of  this  operation,  before  all 
inflammatory  tenderness  of  the  parts  involved,  subsided. 

During  this  long  period,  the  unsightly  fold  of  integuments  left  for  the  sup- 
port of  the  glans,  occasioned  not  a  little  annoyance  to  the  patient,  as  its 
bulk  and  peculiar  form  continually  admonished  him  that  the  organ  was  yet 
imperfect,  and  reminded  him,  too,  that  another  operation  yet  awaited  him 
before  the  cure  could  be  effected,  which  he  now  greatly  dreaded.  Three 
months  from  the  date  of  the  first  operation  a  second  was  performed  for  the 
removal  of  the  fold  of  integuments,  already  so  often  referred  to.  This  was 
accomplished  by  first  rapidly  excising  the  parts  with  a  strong  pair  of  scis- 
sors nearly  down  to  the  depth  of  their  union >  and  then  cautiously  dissecting 


1842.]  Meiiaue![  on  Hypospadias  and  Epispadias.  55 

away  the  remaining  portions,  taking  care  to  leave  no  more  integuments  than 
sufficient  to  render  the  organ  comely.  The  latter  step  of  this  operation  was 
executed  with  less  ease  than  might  have  been  imagined,  as  it  required  great 
care,  and  was  accomplished  amidst  torrents  of  blood  pouring  from  four  or 
five  pretty  large  arteries,  two  of  which  required  the  ligature.  As  soon  as 
the  superfluous  textures  were  dissected  away  the  margins  of  the  skin  were 
carefully  approximated,  and  confined  by  eight  interrupted  sutures.  Over 
these,  adhesive  plasters  applied  around  the  penis  were  next  used,  and  the 
whole  supported  by  a  narrow,  soft  bandage,  put  on  just  firmly  enough  to 
impart  the  necessary  support  to  the  under  dressing.  On  the  fourth  day  the 
wound  was  examined  and  redressed;  and  in  two  weeks  the  sutures  were  cut 
away,  and  the  parts  found  to  be  firmly  united  and  well.  After  this  the  only 
dressing  used  to  the  cicatrix  (Fig.  3,  a,  b)  was  a  strip  of  soft  old  linen  spread 
with  simple  cerate,  long  enough  to  encircle  the  organ,  and  confined  by  a 
light  bandage  merely  to  prevent  the  abrasion  of  its  delicate  cuticle. 

The  penis  now  presented  a  very  natural  appearance,  and  was  fully  two 
inches  in  length  during  the  non-erected  state,  measuring  from  the  scrotum* 
The  glans,  too,  which  had  lost  its  sensibility  from 
the  moment  the  intermediate  skin  between  it  and 
the  stump  was  divided,  had  in  some  slight  degree 
at  this  period  recovered  its  feeling,  and  it  manifested 
a  decided  erectile  blush,  and  some  expansion  from 
friction;  or,  from  compression  of  the  root  of  the 
organ:  during  venereal  excitation,  these  changes 
were  also  to  be  perceived  in  it.  In  the  erected 
state,  the  penis  measured  nearly  four  inches  and  a 
half  in  length,  and  presented  in  all  respects  a  most  natural  appearance;  and,, 
doubtless,  will  be  found  perfectly  useful,  after  the  contracted  portion  of  the 
urethra  shall  have  been  restored  to  its  proper  condition,  and  the  perinaeal 
opening  closed. 

It  was  judged  advisable  to  defer  the  operations  for  restoring  the  urethra 
to  its  pervious  and  proper  condition,  as  well  as  for  closing  the  preternatural 
opening  in  the  perina^um  permanently,  until  the  parts  previously  operated 
upon  should  entirely  recover  from  all  inflammatory  tenderness,  and  become 
firm  and  healthy.  In  accordance  with  this  view  several  months  elapsed 
after  the  removal  of  the  tegumentary  intermedium,  before  we  attempted  the 
operations  designed  to  open  the  contracted  portion  of  the  urethra,  and  to 
close  the  opening  of  the  perinaeum  permanently.  The  case  at  length  being 
favourable  for  the  execution  of  this  operation,  first  exposing  the  part  to  a 
strong  light,  we  commenced  by  placing  a  probe  curved  near  its  extremity,. 
in  the  perinaeal  opening,  with  the  point  firmly  pressed  in  the  direction  of  the 
glans  into  the  cul  de  sac  at  the  termination  of  the  inferior  urethra,  which  was 
then  passed  into  the  hands  of  an  assistant  to  be  held  steadily.  The  penis 
was  next  elevated  so  as  to  form  nearly  a  light  angle  with  the  abdominal 


56  Mettauer  on  Hypospadias  and  Epispadias.  [July 

wall,  and  firmly  held  with  the  left  hand  embracing  it  low  down,  with  the 
middle  finger  placed  along,  and  supporting  the  rapheal  line  corresponding 
with  the  passage  to  be  opened.  In  this  situation  a  h)ng  trocar  was  intro- 
duced at  the  meatus,  and  carried  quite  down  through  the  anterior,  or  supe- 
rior urethra  to  its  cul  de  sac,  with  the  concavity  to  the  symphisis,  and  the 
lancet  retracted  within  the  canula,  held  and  directed  with  the  right  hand. 
The  blunt  extremity  of  the  canula  w  as  now  pressed  firmly  into  the  bottom 
of  the  cul  de  sac;  and  after  giving  it  the  proper  direction,  the  lancet  was  pro- 
jected from  its  concealment  about  five  lines  and  immediately  retracted  within 
the  canula.  The  canula  was  now  pressed  onward  so  as  to  fill  the  part 
incised  quite  to  the  bottom,  and  in  this  situation  the  lancet  was  again  pro- 
jected as  already  described.  In  this  manner  the  operation  was  repeated 
until  the  extremity  of  the  canula  entered  the  inferior  portion  of  the  urethra 
announced  by  the  displacement  of  the  probe  from  its  cul  de  sac.  The  trocar 
was  then  withdrawn,  the  lancet  having  been  previously  retracted  within  its 
canula,  and  the  entire  passage  from  the  meatus  to  the  bladder  immediately 
filled  with  a  gum  elastic  tube  of  proper  size.  Care  was  taken  not  to  carry 
the  tube  more  than  the  depth  of  its  proximal  aperture  into  the  bladder,  so 
that  the  urine  might  be  completely  decanted  from  its  cavity. 

We  next  touched  every  part  of  the  opening  of  the  perinseum,  from  its  ex- 
ternal margins  quite  down  to  the  tube,  with  a  delicate  stick  of  nitras  argenti, 
so  as  to  cauterize  effectually;  and  after  the  eschars  were  carefully  scraped  off 
with  a  small,  delicate  scalpel  so  as  to  expose  a  new  denuded  surface,  the 
opening  was  closed  with  two  points  of  the  interrupted  suture,  inserted  from 
within  outwardly  down  to  the  tube,  and  fully  eight  lines  from  the  margins. 
Thus  inserted,  the  threads  when  tightened  and  tied,  closed  the  opening  com- 
pletely. A  compress  was  now  placed  upon  the  sutures  supported  by  a  T 
bandage  applied  with  moderate  firmness.  Finally,  the  tube  was  guarded 
with  a  stopper,  and  confined  as  already  advised,  to  prevent  its  displacement 
from  the  urethra.  We  directed  that  the  bladder  should  be  evacuated  every 
second  or  third  hour,  to  guard  as  far  as  possible  against  the  passage  of  urine 
around  the  tube;  an  accident  which  might  occur  in  the  event  of  a  large  accu- 
mulation of  water  in  the  bladder  taking  place. 

In  this  situation  the  case  was  suffered  to  remain  five  days,  durino-  which 
time  we  found  it  necessary  to  administer  two  mild  cathartics,  and  to  confine 
the  patient  in  bed,  and  to  a  very  abstemious  diet.  At  this  period  the  tube 
was  carefully  removed,  and  the  parts  found  to  be  in  a  most  favourable  condi- 
tion for  a  speedy  and  perfect  cure.  The  urethra  suppurated  freely,  but  not 
too  much  so;  and  the  margins  of  the  perinaeal  opening  seemed  firmly  united. 
The  sutures  were  not  cut  away,  as  they  seemed  yet  firm.  A  fresh  tube  was 
introduced  without  the  wire,  guarded  and  secured  as  the  first,  and  was  kept 
in  the  passage  three  days  more.  After  this  the  tube  was  only  introduced 
during  urination,  to  prevent,  if  possible,  any  stress  from  the  flow  of  water 
along  the  urethra  upon  the  newly  closed  permseal  opening.     On  the  twelfth 


1842.]  M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marrow.       57 

day  the  sutures  were  cut  away  and  the  margins  of  the  opening  found  to  be 
firmly  and  perfectly  united. 

We  advised  tlie  patient  to  introduce  a  tube  or  bougie  .through  the  newly 
formed  passage,  at  least  once  a  day  for  a  year,  and  after  that  period  to  em- 
ploy it  occasionally  to  prevent  its  contraction. 

The  urethra  was  now  free  from  all  tenderness,  and  transmitted  the  urine 
from  the  bladder  in  a  bold  and  full  stream. 

Thus  modified,  there  is  litde  doubt  but  the  penis  will  prove  useful  for  all 
purposes;  and  compensate  the  young  man  for  the  pain  and  suffering  he 
endured  from  the  different  operations  performed  for  his  relief. 

Prince  Edward  C.  H.,  Va.,  April  21,  1842. 


Art.  IV. — Cases  of  Disease  of  the  Brain  and  Spinal  Marroiv.  By  James 
M'Naughton,  M.  D.,  Professor  of  Theory  and  Practice  of  Medicine  in 
the  Albany  Medical  College. 

No  diseases  have  of  late  years  engaged  the  attention  of  the  medical  pro- 
fession more  than  those  of  the  brain  and  spinal  marrow.  Much  yet  remains 
to  be  done  before  the  obscurity  in  which  these  diseases  are  involved  is 
removed.  The  following  cases  are  deemed  of  sufficient  interest  to  deserve 
to  be  put  on  record,  as  examples  of  some  of  the  most  formidable  of  their 
class. 

Case  I.  Mr.  F.  F.  was  a  professional  gentleman  of  high  character  and 
respectability,  who  had  enjoyed  good  health  until  the  autumn  of  1837. 
During  the  cholera  in  1832  he  was  a  good  deal  indisposed,  whether  from 
the  epidemic  influence,  or  merely  from  the  anxiety  which  most  people  felt 
during  that  gloomy  period,  it  would  be  difficult  to  determine.  He  then  got 
into  the  habit  of  taking  medicine  to  ward  off  an  attack  of  the  disease;  but, 
unfortunately,  he  continued  to  tamper  with  medicines  after  the  cessation  of 
the  epidemic,  to  the  injury  of  his  digestive  organs. 

About  the  beginning  of  October,  1837,  while  engaged  in  some  perplexing 
business,  which  required  his  occasional  absence  from  town,  he  returned 
home,  labouring  under  what  appeared  to  be  a  common  cold,  namely,  chilli- 
ness, headache,  some  oppression  of  breathing,  cough,  white  tongue,  and 
derangement  of  the  digestive  organs.  In  the  course  of  a  few  days,  he  be- 
came so  much  worse  that  I  was  called  in.  I  found  his  pulse  under  50  in  a 
minute,  skin  cool,  tongue  much  loaded  with  a  whitish,  slimy  mucus;  coun- 


58        M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marroiu.    [July 

tenance  loaded  and  heavy;  the  right  eye  suffused  and  cloudy.  He  also  com- 
plained of  headache,  and  was  slightly  delirious.  Regarding  the  case  as  one 
of  congestive  fever,  I  attempted  to  draw  blood  from  the  arm;  but  the  circu- 
lation was  so  languid  that  very  little  was  discharged.  The  patient  lay  in  a 
drowsy,  torpid  state,  but  when  roused  could  give  rational  answers  to  ques- 
tions. Sinapisms  to  the  extremities  and  abdomen,  friction  over  the  integu- 
ments, and  an  epispastic  to  the  neck,  were  directed,  with  a  view  of  causing 
a  freer  determination  of  blood  to  the  surface,  and  of  relieving  the  internal 
organs  from  oppression.  These  answering  the  purpose  but  imperfectly,  it 
was  thought  that  an  emetic,  by  unloading  the  stomach,  and  by  its  influence 
on  the  abdominal  and  other  secretions,  would  answer  a  good  purpose.  A 
full  dose  of  ipecacuanha,  in  combination  with  five  grains  of  sulphate  of  zinc, 
was  directed  to  be  administered,  if  reaction  was  not  soon  re-established. 

In  less  than  an  hour  I  was  sent  for  in  great  haste.  I  was  informed  that 
my  patient  was  vomiting  blood  very  profusely.  Upon  reaching  the  house, 
I  ascertained  that  half  a  chamber-potful  of  black  looking  stuff  had  been 
thrown  off  the  stomach.  By  candlelight  I  could  not  well  determine  the 
true  character  of  what  was  brought  up;  but  it  did  not  seem  to  be  blood, 
but  a  vitiated  biliary  secretion.  Such  proved  to  be  the  case  when  I  ex- 
amined it  by  daylight.  The  emetic  had  not  been  exhibited,  consequently 
the  vomitmg  was  spontaneous.  The  stupor  and  oppression  were  relieved  by 
the  vomiting,  which  was,  therefore,  for  a  while  promoted  by  drinking  warm 
water.  Afterwards  the  bowels  were  opened  by  a  purgative  enema;  and  when 
the  stomach  became  sufficiently  settled  to  retain  medicine,  a  full  dose  of 
calomel  was  given,  and  followed  in  a  few  hours  by  a  suflacient  dose  of  cas- 
tor oil,  to  procure  several  free  evacuations.  These  for  several  days  conti- 
nued to  have  the  same  general  character  with  the  discharges  from  the  sto- 
mach, dark  and  pitchy.  In  the  course  of  a  week,  however,  the  evacuations, 
by  the  use  of  gentle  purgatives,  acquired  a  natural  appearance,  the  tongue 
became  clean,  and  the  patient  gradually  recovered  his  health,  without  any 
occurrence  worthy  of  record.  During  the  early  part  of  the  attack,  there 
was  a  retention  of  urine,  so  that  the  catheter  had  to  be  used  for  more  than 
a  week,  to  prevent  injurious  accumulation  in  the  bladder. 

During  the  winter  of  1837-38,  he  enjoyed  a  tolerably  good  share  of 
health,  and  attended  to  his  professional  duties.  In  March  1838,  business 
required  his  going  to  New  York.  The  weather,  as  often  happens  in  that 
inclement  month,  was  cold  and  wet,  and  he  suffered  from  exposure,  both 
on  the  voyage  down  the  river,  and  during  his  stay  in  the  city.  He  returned 
to  Albany,  complaining  of  headache,  pains  about  the  chest  and  shoulders, 
cough,  and  general  indisposition.  On  the  1st  of  April  he  had  a  second 
attack  of  vomiting  of  black  matter,  like  that  of  the  preceding  year,  attended 
by  symptoms  so  exactly  similar,  that  it  would  be  useless  to  repeat  them. 
The  same  general  plan  of  treatment  was  pursued  as  on  the  former  occasion, 
^^(J  with  sirflil3r  result?,  ej^cept  th^t  his  recovery  was  much  slower,     The 


1842.]  M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marrow.        59 

stupor,  low  delirium,  slow,  languid  pulse,  attended  with  dark  discharges 
from  the  bowels  and  retention  of  urine,  continued  for  more  than  a  week. 
All  the  symptoms,  however,  gradually  yielded,  and  I  anticipated  as  happy 
a  termination  as  on  the  first  attack.  In  about  three  weeks  the  patient  was 
able  to  sit  up  and  get  dressed;  his  tongue  became  tolerably  clean;  his  appe- 
tite orood;  his  mind  clear  and  cheerful.  There  seemed  no  reason  to  doubt  of 
his  entire  recovery. 

His  strength,  however,  did  not  return  so  fast  as  might  be  expected  from 
his  good  appetite,  and  the  quantity  of  food  he  took  with  apparent  relish. 
His  pulse  continued  slower  and  softer  than  natural,  and  the  temperature  of 
his  skin  remained  low.  His  walk  was  peculiarly  unsteady  and  tottering, 
but  he  made  little  complaint  of  uneasiness  in  the  head,  and  not  much  even 
of  dizziness.  When  his  arms  were  in  a  dependent  position,  the  hands  felt 
cold  and  clammy,  and  the  blood  seemed  stagnant  in  the  capillaries,  giving 
the  skin  a  dark  purplish  hue,  leaving  a  white  streak  when  the  finger  was 
drawn  along  the  skin,  not  unlike  that  produced  in  the  blue  stage  of  the  Asi- 
atic cholera.  In  this  general  condition  he  remained  for  two  or  three  weeks, 
rather  losing  than  gaining  in  muscular  strength.  One  day  when  I  called  to 
see  him,  I  found  him  sitting  in  an  arm  chair,  his  forearm  and  hands  hanging 
over  the  arms  of  the  chair.  I  asked  him  to  raise  his  hand  that  I  might 
examine  his  pulse;  when  I  ascertained,  to  my  surprise,  that  he  had  not  the 
power  to  do  so.  On  my  former  visits,  he  was  either  in  bed,  or  had  his 
arms  supported,  so  that  I  did  not,  from  his  general  appearance  and  symp- 
toms, suspect  that  there  was  any  tendency  to  palsy,  although  his  wife  had 
repeatedly  told  me  that  her  husband  was  every  day  becoming  weaker  instead 
of  stronger.  I  did  not  give  heed  to  this  warning,  believing  it  to  be  nothing 
more  than  the  impatience  not  unfrequently  observed  among  the  friends  of 
the  sick.  The  warning,  however,  was  well-timed;  for,  upon  closer  inquiry, 
I  found  out  that  my  patient  had  in  point  of  fact  lost,  to  a  considerable 
degree,  the  power  of  voluntary  motion  of  both  the  upper  and  lower  extremi- 
ties, attended  with  some  perversion  of  sensation,  but  no  actual  pain.  Ex- 
cepting that  the  patient  was  more  irascible  than  usual,  there  was  no  marked 
disturbance  of  the  mental  faculties,  no  headache,  and  no  pain  or  tenderness 
on  pressure  along  the  spine. 

I  therefore  considered  the  palsy  the  effect  of  the  long  continued  conges- 
tion of  blood  in  the  vessels  of  the  brain  and  spinal  marrow,  connected,  per- 
haps, with  more  or  less  serous  effusion  within  the  cranium.  I  expected 
that  it  would  gradually  yield  under  proper  treatment,  as  the  injured  organs 
recovered  their  wonted  condition. 

As  the  history  of  the  case  indicated  at  least  severe  functional  disturb- 
ance of  the  liver  and  associated  organs,  a  mild  mercurial  course  seemed  to 
be  indicated.  The  patient  was  accordingly  put  upon  a  course  of  blue  pills, 
laxatives,  vegetable  tonics,  and  nutritive  diet,  for  the  improvement  of  the 
general  health,  while  cupping  on  the  nape  of  the  neck  and  along  the  spine, 


60       M'Naughtoii  on  Diseases  of  the  Brain  and  Spinal  Marrow,    [July 

followed  by  blisters,  issues,  &c.,  were  had  recourse  to  for  the  purpose  of 
acting  more  immediately  on  the  nervous  centres.  Under  this  treatment  he 
gradually  improved,  so  as  to  be  able  to  walk  about  the  room,  with  the  aid  of 
a  cane,  or  the  arm  of  an  assistant.  While  in  this  condition,  some  officious 
friend  put  into  his  hand  a  pamphlet,  showing  the  almost  miraculous  effects 
of  electricity  in  cases  like  his.  Nothing  would  satisfy  his  friends  but  a  trial 
of  that  potent  agent.  It  was  tried,  contrary  to  my  advice,  for  about  a  week, 
when,  seeing  that  it  was  doing  harm,  I  remonstrated  against  its  further 
employment,  and  it  was  discontinued. 

After  this,  it  was  thought  best  to  take  him  into  the  country  during  the 
hot  weather  of  July  and  August.  After  spending  a  few  weeks  in  the  coun- 
try, he  returned  to  town,  rather  injured  than  benefited  by  the  excursion. 
He  had  suffered  several  times  from  imprudent  exposure  to  currents  of  damp 
air  during  his  absence. 

In  October  he  made  a  journey  to  Boston,  and  returned  by  way  of  New 
York.  This  excursion,  like  the  visit  to  the  country,  proved  of  no  benefit 
to  him.  My  duties  at  the  College  of  Physicians  and  Surgeons  of  the 
Western  District,  required  my  absence  from  Albany,  from  the  1st  Nov. 
1838  to  the  20th  of  January,  during  which  time  my  patient  had  several  ill 
turns  of  a  comatose  character,  bordering  on  apoplexy.  On  my  return,  I 
resumed  charge  of  the  case,  directed  attention  to  the  state  of  the  digestive 
organs,  had  recourse  to  cuppings  and  blisters  along  the  spine,  an  issue  in 
the  nape  of  the  neck,  and  stimulating  frictions  to  the  limbs  and  trunk  of 
the  body. 

Under  this  treatment  he  again  improved,  began  to  acquire  the  use  of  his 
limbs,  could  walk  the  room  with  a  little  assistance,  and  in  good  weather 
was  able  to  ride  out.  We  again  began  to  hope  for  a  favourable  result;  but 
this  encouraging  state  of  things  did  not  last  long.  About  the  beginning  of 
May,  1839,  he  began  to  complain  of  what  he  regarded  as  rheumatic  pains 
in  the  joints.  The  pains  were  at  first  confined  to  the  neck,  elbows,  knees 
and  groins.  The  pains  came  on  in  paroxysms,  attended  with  spasmodic 
contractions  of  the  limbs.  At  first  the  contractions  ceased  with  the  parox- 
ysm of  pain,  but  by  degrees  the  contractions  became  permanent — subject, 
however,  to  occasional  aggravation.  Any  attempt  to  extend  the  limbs  forci- 
bly, caused  immediate  spasmodic  contraction  with  excruciating  pain.  Both 
the  upper  and  lower  extremities  became  permanently  contracted;  but  the 
lower  to  a  greater  degree  than  the  upper,  and  attended  with  more  pain. 
He  could  use  his  fingers,  to  a  certain  extent,  during  the  whole  course  of 
the  disease,  but  had  little  power  over  the  larger  joints.  The  knees  were 
drawn  up  towards  the  abdomen,  and  the  legs  bent  upon  the  thighs,  so  that 
the  heel  rested  firmly  upon  the  soft  parts  covering  the  tuber  ischii.  Any 
attempt  to  extend  the  limb  caused  pain,  and  was  immediately  followed  by  a 
forcible  retraction  of  it  to  its  former  position. 

The  surface  of  the  body  during  the  early  stages  of  the  contractions  of 


1842.]  M^Naughton  on  Diseases  of  the  Brain  and  Spinal  Marrow.        61 

the  limbs  was  morbidly  sensitive  to  the  touch;  so  much  so  that  the  mere 
approach  of  a  person  to  the  patient  frequently  caused  him  to  cry  out  from 
fear  of  being  hurt.  He  appeared  to  suffer  excruciating  agony  whenever  it 
became  necessary  to  move  him. 

The  case  remained  for  several  months  very  much  in  this  state,  in  spite 
of  every  effort  made  for  his  i-elief,  with  very  little  amendment,  except  a 
gradual  diminution  of  pain.  I  need  not  enumerate  all  the  means  employed. 
They  were  those  generally  used  in  cases  of  Myelitis,  with  the  addition 
occasionally  of  other  means  to  obviate  derangements  occurring  in  the  func- 
tions of  other  organs  in  so  protracted  a  disease. 

After  the  regular  faculty  had  in  a  measure  given  up  all  hope  of  a  cure,  a 
German  empiric  tried,  for  several  months,  the  effects  of  warm  baths,  and 
various  external  and  internal  applications,  but  without  any  permanent  ad- 
vantage. 

The  patient  became  gradually  emaciated;  cough  and  bronchitis  came  on, 
attended  with  fever  of  the  hectic  type.  Towards  the  close  of  December, 
1840,  the  fever  became  more  severe,  mild  delirium  set  in,  and  on  the  even- 
ing of  the  28th  of  January,  1841,  the  aifficted  sufferer  breathed  his  last  in 
the  41st  year  of  his  age. 

In  the  whole  course  of  a  long  and  extensive  practice,  I  have  not  seen  a 
case  in  all  respects  so  lamentable,  or  so  well  calculated  to  excite  the  sym- 
pathy of  every  feeling  heart.  The  patient,  a  gentleman  of  fine  talents,  in 
the  prime  of  life,  in  the  highest  position  in  society,  and  surrounded  by  every 
thing  that  could  make  life  desirable,  was  cut  off  for  several  weary  years 
from  all  his  enjoyments,  and  at  last  for  several  months,  stretched  as  it  were 
on  the  rack,  a  helpless,  hopeless  sufferer.  If  death  be  ever  welcome,  it 
must  truly  be  in  such  a  case.  During  the  greater  part  of  this  severe  and 
protracted  illness,  the  digestive  organs  performed  their  functions  tolerably 
well,  and  the  mental  operations,  with  occasional  exceptions  of  no  long 
duration,  were  not  seriously  impaired.  During  the  last  year  of  the  patient's 
life  he  had  complete  amaurosis  of  the  right  eye.  The  condition  of  this  eye 
before  the  state  of  amaurosis  came  on,  corresponded  with  the  several  exa- 
cerbations of  the  disease,  being  uniformly  inflamed  and  turbid  whenever 
there  existed  any  considerable  febrile  disturbance  of  the  system,  and  subsid- 
ing with  the  febrile  symptoms. 

Having  requested  permission  to  have  the  body  examined,  leave  was 
granted. 

Post  mortem  appearances  of  the  brain  and  spinal  canal. 

At  11  o'clock  A.  M.,  Jan.  21st,  1842,  proceeded  to  examine  the  body  in 
the  presence  of  Professors  Hun  and  Armsby  of  the  Albany  Medical  College, 
my  brother  Dr.  I.  M'Naughton,  and  several  medical  students  and  friends  of 
the  deceased. 

The  roof  of  the  cranium  was  removed  in  the  usual  manner  by  the  saw. 

Dura  mater.  The  dura  mater  was  more  firmly  adherent  to  the  cranium 
No.  VII.— July,  1842.  6 


62        M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marrow.     [July 

than  is  usual  in  adults.  The  os  frontis  was  thickened,  particularly  on  its 
inner  table,  from  a  little  above  the  superciliary  ridge  to  the  coronal  suture. 
Numerous  spiculae  of  bone  on  the  inner  table,  some  of  which  penetrated 
between  the  fibres  of  the  dura  mater.  On  the  left  side  of  the  mesial  line  a 
portion  of  dura  mater  of  the  size  of  a  finger-nail  absorbed,  corresponding  to 
the  situation  of  a  bony  prominence  on  the  inner  table  of  the  skull.  No 
other  morbid  appearance  on  dura  mater. 

Arachnoid.  Arachnoid  opaque  over  the  hemispheres,  presenting  nume- 
rous pale  granulations  for  some  distance  on  each  side  of  longitudinal  sinus. 
Copious  effusion  of  serum  between  arachnoid  and  pia  mater,  filling  the  fur- 
rows between  the  convolutions.  Pia  mater.  No  unusual  vascularity,  or 
turgescence  of  capillaries.     No  morbid  appearance  of  note. 

Hemispheres.  General  appearance  healthy;  consistency  firm;  convolu- 
tions uncommonly  deep.  In  the  fore  part  of  the  right  hemisphere  above 
the  anterior  eornu  of  the  lateral  ventricle  was  observed  what  seemed  to  be 
the  vestige  of  a  small  cavity.  No  morbid  appearances  seen  in  the  interior 
of  other  parts  of  the  brain  or  cerebellum. 

Under  surface  of  the  brain  and  cerebellum.  Pia  mater  and  arachnoid  of 
the  same  appearance  as  on  the  upper  surface,  excepting  that  there  were  no 
granular  bodies  on  the  arachnoid.  The  same  kind  of  clear  serum  between 
the  membranes  and  in  the  intervals  between  the  convolutions. 

Optic  nerve  of  the  right  side  from  the  eye  to  the  optic  commissure  smaller, 
rounder  and  firmer  than  that  of  the  left;  no  perceptible  difference  in  the 
optic  tracts  behind  the  commissure.  The  optic  thalamus  of  the  left  side  on 
its  outer  and  back  part  softer  than  that  of  the  right.  Tuber  annulare  firmer 
than  usual;  corpora  pyramidalia  and  olivaria  very  prominent  and  firm;  me- 
dulla oblongata  very  firm. 

Spinal  marrow.  From  the  foramen  magnum  to  the  first  or  second  dorsal 
vertebra  all  the  membranes  of  the  spinal  marrow  firmly  united,  and  much 
thickened;  dura  mater  united  to  the  posterior  common  ligament  of  the  spine 
throughout  the  cervical  region.  The  marrow  in  the  same  region  very  soft; 
on  its  back  part  semifluid.  From  the  second  dorsal  vertebra  to  the  lower 
end  of  the  spinal  canal  the  sheath  of  the  spinal  marrow  was  distended  with 
a  very  clear  serum.  The  lower  end  of  the  spinal  marrow  firmer  than  usual, 
and  together  with  the  cauda  equina  of  a  beautiful  roseate  hue,  but  without 
distinct  vessels.  No  appearance  of  flakes  of  coagulable  lymph  on  the  mem- 
branes of  the  brain  or  marrow,  or  in  the  serum — nothing  that  indicated 
recent  acute  inflammation. 

From  the  permission  granted  we  did  not  feel  at  liberty  to  examine  the 
thoracic  and  abdominal  viscera. 

The  contraction  of  the  lower  extremities  was  so  excessive  that  we  were 
obliged  to  divide  the  hamstrings  to  get  the  body  into  the  coffin. 

Case  II.  Mr.  B.,  a  medical  student,  some  time  in  the  month  of  November 


1842.]  M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marroio.       63 

last,  when  returning  from  the  college  to  his  lodgings,  fell  in  the  street  and 
hurt  himself.  He  complained  particularly  of  the  "jar"  his  head  had  re- 
ceived; but  I  could  not  learn  from  himself  that  his  head  had  actually  struck 
the  ground,  although  his  companions  were  of  the  opinion,  from  what  he  had 
told  them  at  the  time,  that  it  had.  From  that  time  he  complained  of  not 
feeling  right  about  the  head;  was  observed  to  be  rather  dull  and  low-spirited 
at  times,  so  that  he  was  teased  about  being  homesick.  He  continued,  how- 
ever, to  attend  lectures  with  tolerable  regularity  until  the  middle  of  Febru- 
ary. At  that  time  he  went  to  the  neighbouring  city  of  Schenectady  to 
attend  a  funeral.  The  weather  was  cold  and  disagreeable,  and  he  thought 
that  he  caught  cold  while  standing  in  the  street  before  the  procession  began 
to  move.  On  the  morning  of  the  17lh  of  February  he  returned  to  Albany, 
complaining  of  not  feeling  well.  At  12  o'clock  A.  M,  of  the  18th,  he  was 
seized  with  a  severe  chill,  like  the  cold  stage  of  an  intermittent,  which  was 
followed  by  a  paroxysm  of  high  fever  and  much  headache.  His  room  com- 
panion, a  medical  student,  gave  him  an  emetic,  and  followed  it  in  the  morn- 
ing by  a  cathartic.  By  these  means  the  fever  was  relieved,  so  that  he 
acknowledged  himself  much  better  next  day.  On  the  morning  of  the  19th, 
at  the  same  hour  with  the  preceding  attack,  he  had  a  second  chill  followed 
by  fever.  His  room  mate  inferred  from  the  recurrence  of  the  chill  at  the 
same  hour  that  the  disease  was  a  quotidian  intermittent,  and  therefore 
thought  the  case  one  in  which  bleeding  in  the  cold  stage  would  be  proper. 
He  accordingly  bled  him  during  the  chill,  but  did  not  take  much  blood 
away.  On  the  20th  he  had  another  slight  chill,  but  it  did  not  come  on  until 
7  o'clock  in  the  morning.  At  this  time  the  young  man's  friend  became 
uneasy  about  him,  and  I  was  requested  to  visit  him.  I  called  in  the  fore- 
noon. When  I  saw  him  his  pulse  was  full  but  not  hard,  and  not  over 
90  in  a  minute;  tongue  white;  skin  warm  and  moist;  countenance  full  and 
flushed;  but  the  flush  variable.  The  breathing  was  rather  slow,  and  the 
speech  rather  more  slow  and  deliberate  than  usual  with  him;  the  voice 
hoarse,  with  a  tendency  to  cough.  He  complained  of  headache,  but  it  was 
not  severe.  He  could  not  sit  up  in  bed  on  account  of  a  sense  of  weakness 
or  faintness  which  he  experienced  when  he  made  the  attempt.  He  did  not 
appear  to  suffer  much  from  the  admission  of  light  into  his  room,  nor  from 
the  ordinary  noises  in  the  street,  but  the  conjunctiva  of  the  eyes  was  some- 
what red.  The  young  man  had  a  fair  complexion,  and  a  skin  of  feminine 
delicacy  and  softness. 

Each  paroxysm  of  fever  was  distinctly  marked  by  the  three  stages  of  an 
ordinary  intermittent — cold,  hot,  and  sweating.  At  the  time  of  my  visit 
there  was  no  delirium,  and  I  could  not  learn  that  there  had  been  any  worth 
speaking  of.  The  symptom.s  did  not  seem  to  indicate  the  necessity  of  any 
very  active  treatment.  I  merely  directed  that  the  bowels  should  be  kept 
open,  and  that  antimonials  should  be  given  while  the  skin  continued  hot  and 


64       M'Naughton  on  Diseases  of  the  Brain  and  Spinal  Marrow,    [July 

dry,  and  gave  suitable  instructions  in  relation  to  diet,  and  the  general  naa- 
nagement  of  the  case. 

From  this  time  to  the  27th  he  continued  to  improve;  had  no  return  of 
chills;  his  hoarseness  and  cough  left  him;  his  tongue  became  clean  and  his 
appetite  returned.  "When  I  saw  him  on  the  27tli  he  was  sitting  up,  looking 
pale  and  v/eak,  but  was  eating  his  dinner  apparently  with  a  good  appetite. 
He  made  no  more  complaint  of  his  head  than  is  usual  with  persons  reco- 
vering from  an  acute  disease.  I  considered  him  convalescent,  'and  hoped 
that  in  a  short  time  he  would  be  able  to  return  home  to  his  friends  in  the 
country. 

I  heard  no  more  of  him  until  the  afternoon  of  the  2d  of  March,  when  I 
was  sent  for  in  great  haste.  I  was  so  situated  at  the  time  that  I  could  not 
visit  him,  but  directed  that  if  there  was  any  thing  urgent  in  the  case  another 
physician  should  be  called  in.  Dr.  Peter  Van  Beuren,  living  within  a  few 
doors  from  him,  was  called  in.  I  was  not  able  to  see  the  patient  until  the 
morning  of  the  .3d  of  March.  The  family  in  which  he  boarded  informed 
me  that  he  had  been  apparently  getting  better  from  the  time  I  last  visited 
him;  that  he  came  down  stairs  from  the  third  story  where  his  room  was 
into  the  second,  and  spent  some  time  there.  On  the  2d  of  March  he  came 
down  into  the  first  or  lower  story,  in  which  the  family  lived,  and  took  din- 
ner with  them.  After  dinner  he  complained  of  headache,  and  about  four  P. 
M.,  had  a  violent  epileptic  fit,  during  which  he  bit  his  tongue  severely.  Dr. 
Van  Beuren  bled  him  freely,  applied  cold  to  the  head,  and  used  other  suita- 
ble means  to  guard  against  undue  determination  of  blood  to  the  head.  The 
fits  returned  three  or  four  times  in  the  course  of  the  evening  and  night; 
When  I  saw  him  next  day  his  face  was  flushed,  and  the  expression  of  his 
countenance  changed;  his  pulse  full  and  strong,  but  not  frequent.  His 
speech  was  slow,  and  his  mental  operations  evidently  sluggish.  The  fits 
did  not  return  after  the  first  night. 

The  attending  physician  treated  the  case  with  judgment  and  energy;  by 
further  bleedings,  both  general  and  topical,  by  cold  applications  to  the  head, 
blisters  to  the  neck  and  forehead,  purgatives,  &;c.,  but  with  no  advantage  to 
the  patient.  He  continued  gradually  to  sink — the  breathing  becoming  more 
slow,  the  mind  more  torpid,  and  the  pulse  irregular  until  he  died,  without  a 
struggle,  at  five  o'clock  on  the  morning  of  the  10th  of  March. 

Post  mortem  examination. — Twelve  hours  after  death,  having  with  some 
difficulty  obtained  permission  to  examine  the  body,  before  its  removal  into 
the  country,  where  the  family  of  the  deceased  resided,  I  proceeded  to  the 
examination,  assisted  by  my  colleague.  Professor  Hun,  Dr.  Van  Beuren,  and 
several  medical  students.  Dr.  Hun  made  minutes  of  the  dissection  at  the 
time.  The  upper  part  of  the  cranium  was  removed  in  the  usual  way.  The 
membranes  of  the  brain  were  then  examined  over  the  hemispheres,  and  the 
brain  and  cerebellum  then  removed  from  their  situation,  having  first  divided 
the  medulla  oblongata  as  low  down  as  possible. 


1842.]  M'Nanghton  on  Diseases  of  the  Brain  and  Spinal  Marrow.        65 

Dura  mater  slightly  injected. 

Arachnoid  smooth,  shining,  and  remarkably  dry  in  its  whole  extent. 

Pia  mater,  no  unusual  turgescence  or  vascularity.  No  serum  between 
the  membranes. 

Left  hemisphere. — Two  abscesses  three-fourths  of  an  inch  in  diameter, 
about  an  inch  below  the  surface,  at  the  upper  and  fore  part  of  the  hemi- 
sphere, above  the  lateral  ventricle,  near  the  mesial  line.  Each  abscess  was 
surrounded  by  an  indurated  cyst,  with  softening  of  the  medullary  substance 
around,  particularly  above  the  abscesses.  Another  abscess  larger  than  the 
above-mentioned,  situated  below  the  lateral  ventricle  in  the  middle  lobe, 
extending  to  its  surface,  with  absorption  or  disorganization  of  the  pia  mater 
and  arachnoid  membranes,  of  half  an  inch  in  diameter.  The  dura  mater  at 
the  corresponding  point  was  sound.  There  was  extensive  softening  of  the 
brain  all  around  this  abscess. 

Right  hemisphere. — An  abscess  similar  to  those  on  the  left  side  and 
nearly  opposite  to  them,  but  situated  on  a  level  with  the  corpus  callosum, 
and  involving  Solly's  commissure.  This  abscess  had  a  process  extending 
towards  the  lateral  ventricle,  but  did  not  penetrate  into  it.  Both  the  cortical 
and  medullary  substances  were  greatly  softened  to  a  considerable  distance 
around  this  abscess.  The  corpus  callosum,  too,  in  the  vicinity  of  the  ab- 
scess, was  uncommonly  soft.  Another  abscess  beneath  the  hippocampi 
extending  into  the  middle  lobe.  Two  abscesses  at  the  base  of  the  posterior 
lobe,  with  general  softening  of  the  entire  lobe. 

The  lateral  ventricles  were  firmer  and  more  contracted  than  usual,  and 
had  hardly  any  serum  in  them.  The  choroid  plexus  and  velum  interpositmn 
exhibited  no  unusual  turgescence,  or  evidence  of  previous  excitement.  The 
brain  in  general  softer  than  natural  both  in  its  white  and  its  grey  matter. 
Corpora  striata,  optic  thalami,  pons  varolii,  crura  cerebri  et  cerebelli,  and 
cerebellum  itself  apparently  sound.  The  pus  in  the  abscesses  was  well 
formed,  had  a  slightly  greenish  tint,  and  exhaled  an  offensive  odour.  Each 
of  the  abscesses  was  surrounded  by  an  indurated  cyst,  and  the  brain  around 
the  cysts  was  so  soft  that  the  cysts  could  be  removed  entire  by  the  forceps. 
There  was  none  of  the  vascularity  or  capillary  turgescence,  which  usually 
indicate  recent  acute  inflammation  around  the  abscesses. 

In  this  case  the  pain  in  the  head  had  never  been  very  severe,  and  there 
was  not  much  delirium  at  any  stage.  Even  in  the  last  there  was  little  more 
than  torpor  of  the  mental  faculties.  At  my  last  visit,  the  night  before  he 
died,  he  answered  all  my  questions  distinctly  and  rationally. 

The  article  has  already  extended  further  than  will,  perhaps,  be  agreeable 
to  readers  of  the  Journal.  I  therefore  forbear  to  make  any  further  remarks 
on  the  above  cases,  at  least  for  the  present.  I  have  endeavoured  to  give  a 
faithful  account  of  the  cases,  and  leave  it  to  others  to  decide  how  far  the 
morbid  appearances  corresponded  in  kind  and  degree  with  the  symptoms  of 
the  disease  as  given  in  the  foregoing  histories^ 


66 


Mutter's  Cases  of  Deformity  from  Burns, 


[July 


Art.  V. — Cases  of  Deformity  from  Burns^  relieved  by  Operation.  By 
Tiios.  D.  Mutter,  M«  D.,  Professor  of  Surgery  in  Jefferson  Medical 
College,  Philad.,  &c. 

In  the  month  of  January,  1841,  I  was  requested  to  attend  Miss  A,  T.  of 
Chesterfield  township,  New  Jersey,  who  h'c  twenty -three  years  had  endured 
much  mental  as  well  as  physical  inconvenience  from  the  effects  of  a  burn 
■which  occurred  when  she  was  five  years  old,  and  involved  the  face,  throat, 
and  upper  part  of  the  thorax  in  front.  The  following  extract  from  her  his- 
tory of  the  case,  will  explain  the  nature  of  the  accident,  as  well  as  'the  treat- 
ment to  which  she  had  been  subjected  before  I  saw  her: — "  I  received  a 
burn  when  five  years  old  by  my  clothes  taking  fire.  My  grandmother  being 
a  great  doetress  nursed  me,  until  prevented  by  indisposition;  and  as  they 
wished  me  to  remain  in  as  comfortable  a  position  as  possible,  my  life  being 
entirely  despaired  of  by  the  family,  medical  aid  was  not  called  in.  Dr. 
Burns,  a  neighbouring  physician,  hearing  of  the  circumstances,  could  not 
refrain  from  calling  to  see  me;  he  called  twice  as  a  friend,  and  was  then  for- 
bidden to  come  again  until  sent  for,  which  was  never  done.  When  about 
11  years  of  age,  an  attempt  was  made  by  Dr.  Cook  of  Bordentown,  to  afford 
some  relief.  Being  young,  I  was  much  alarmed,  and  opposed  him.  My 
near  relations,  being  unwilling  to  see  me  suffer,  united  with  me;  and  he  was 
obliged  to  desist  before  completing  his  design.  I  therefore  did  not  experi- 
ence any  relief,  and  have  been  unable  to  throw  my  heml  to  the  left  side,  or 


Fig.  1. 


backwards,  or  to  close 
my  mouth  for  more 
than  a  few  seconds  at 
a  time  for  23  years. 
My  right  eye  was  also 
dranm  doiun  some  dis- 
tance beloio  the  other, 
and  when  I  endea- 
voured to  turn  my  he^d, 
it  was  entirely  closed. 
My  condition  has  been 
most  humiliating,  and 
made  life  a  burthen;  but 
having  good  health,  I 
strove  to  reconcile  my- 
self to  my  hard  lot!" 
In  addition  to  the  symp- 
toms so  vividly  de- 
scribed,   I    found     the 


1842.]  Mutter's  Cases  of  Deformity  from  Burns.  67 

angles  of  the  lower  jaw  altered,  and  the  incisor  teeth  nearly  horizontal,  (as 
is  seen  in  cases  of  chronic  hypertrophy  of  the  tongue,)  by  the  pressure  of  the 
tongue,  which  organ,  in  consequence  of  the  inability  of  the  patient  to  close 
the  mouth,  was  always  visible,  and  indeed  protruded,  when  she  was  silent. 
The  clavicle  on  the  right  side  was  also  so  completely  embedded  in  the 
cicatrix,  that  it  could  scarcely  be  felt,  and  there  was  no  external  indication 
of  its  location.  The  chin  from  the  shortness  of  the  bands  was  drawn  down 
to  within  one  inch  and  a  half  of  the  top  of  the  sternum,  and  the  head  con- 
sequently inclined  very  much.  The  space  between  the  chin  and  sternum 
was  also  filled  up  by  the  cicatrix,  so  that  no  depression  existed  in  front  of  her 
neck.  Fig.  1,  which  represents  her  full  face,  affords  a  very  correct  idea 
of  her  af)pearance.  After  carefully  examining  the  case,  and  fully  explaining 
to  the  patient  and  her  friends  the  inutility  of  any  of  the  usual  operations  for 
such  deformities,  I  proposed  to  them  one  entirely  different  in  its  principle, 
which  although  severe,  as  well  as  somewhat  hazardous,  promised  partial,  if 
not  entire  relief.  To  this  my  patient  readily  assented,  declaring  that  death 
were  preferable  to  a  life  of  such  misery  as  hers.  In  conformity  with  her 
wishes,  I  at  once  placed  her  on  a  preparatory  treatment,  and  on  the  12th  of 
January,  performed  the  operation  to  be  described,  assisted  by  Drs.  Noble 
and  Pierce,  and  in  the  presence  of  Messrs.  Ward,  Ducachet,  Mason  and 
Egan,  medical  students. 

The  patient  being  placed  in  a  strong  light,  and  seated  on  a  low  chair,  her 
head  was  thrown  back  as  far  as  possible,  and  sustained  in  this  position  by 
an  assistant. 

Seating  myself  in  front,  I  began  the  operation  by  making  an  incision 
which  commenced  on  the  outside  of  the  cicatrix  in  sound  skin,  and  passed 
across  the  throat  into  sound  skin  on  the  opposite  side.  This  penetrated 
merely  through  the  integuments,  and  was  made  as  near  the  centre  of  the 
cicatrix  as  possible.  It  was  therefore  about  three  quarters  of  an  inch  above 
the  top  of  the  sternum,  and  of  course  in  the  most  vital  part  of  the  neck.  My 
object  in  making  it  so  low  down  was  to  get  at  the  attachments  of  the  sterno- 
cleido-mastoid  muscles,  which  in  consequence  of  the  long  flexion  of  the  head, 
were  not  more  than  three  inches  in  length,  and  required  on  one  side  com- 
plete, and  on  the  other  partial  division,  before  the  head  could  be  raised. 
The  integuments  having  been  thus  divided,  I  next  carefully  dissected 
through  the  cicatrix  until  I  reached  the  fascia  superficialis  colli,  which  I  could 
readily  detect,  and  then  going  on  still  deeper,  I  exposed  the  sterno-cleido- 
mastoid  muscle  of  the  right  side,  and  passing  a  director  under  it,  as  low 
down  as  possible,  divided  both  its  attachments.  This  enabled  me  to  raise 
the  head  an  inch  or  two;  but  finding  that  it  was  still  kept  down  by  the 
sterno-cleido-mastoid  of  the  left  side,  I  divided  the  sternal  attachment  of  this 
muscle,  and  was  much  gratified  to  find  that  the  head  could  at  once  be  placed 
in  its  proper  position,  the  clavicular  attachment  of  the  muscle  offering  little  or 
no  resistance.     A  most  shocking  wound  six  inches  in  length  hy  five  and  a 


68 


Mutter's  Cases  of  Deformity  from  Burns. 


[July 


•'^^ff-  ^'  half  in  width.,  was 

thus  made,  and  yet 
there  was  scarce- 
ly any  hemorrhage; 
three  or  four  ves- 
sels only  requiring 
the  ligature.  (See 
Fig.  2.) 

The  next  step  in 
the  operation  con- 
sisted in  the  detach- 
ment of  a  flap  of 
sound  skin  with 
which  this  chasm 
could  be  filled;  for  I 
knew  very  well,  that 
if  permitted  to  heal 
by  granulation  only, 
the  patient,  so  far 
from  being  benefit- 
ed, would  be  made  worse  than  before.  To  obtain  this  flap,  I  com- 
menced at  the  terminal  extremity  of  the  incision,  and  carrying  the  scalpel 
downivards  and  outwards  over  the  deltoid  muscle,  dissected  up  an  oval 


Fig.  3. 


piece  of  integument  six 
inches  and  a  half  in 
length,  by  six  in  luidth, 
leaving  it  attached  at 
the  upper  part  of  the 
neck,  (see  fig.  2.)  This 
dissection  was  painful, 
butnotbloody,  only  one 
small  vessel  being  open- 
ed. The  flap  thus  de- 
tached was  next  brought 
round  by  making  a 
half-turn  in  its  pedicle, 
placed  in  the  gap  it  was 
destined  to  fill,  and  care- 
fully attached  by  seve- 
ral twisted  sutures,  to 
the  edges  of  the  wound, 
^  (see  fig.  3.)  Several 
straps  were  then  applied 
to  support  the  sutures, 


1842.]  M'dtter^s  Cases  of  Deformity  from  Burns,  69 

but  no  other  dressing  was  deemed  advisable.  The  edges  of  the  wound 
on  the  shoulder  from  which  the  flap  had  been  removed,  were  next  brought 
together  by  straps  and  sutures,  and  with  the  exception  of  its  upper  third, 
was  completely  covered  in.  A  pledget  of  lint  moistened  with  warm  water 
was  laid  upon  this  raw  surface,  a  bandage  applied  by  which  the  head  was 
carried  backwards  and  maintained  in  this  position,  and  the  patient  put  to  bed. 
The  fortitude  with  which  this  truly  severe  operation  was  borne  excited 
the  admiration  of  all  present.  Scarcely  a  groan  escaped  the  patient,  nor 
was  it  necessary  to  give  her  more  than  a  mouthful  or  two  of  wine  and  water 
during  the  whole  period  of  its  duration. 

Rest  and  quietude  were  enjoined,  and  the  patient  prohibited  from  taking 
any  kind  of  nourishment,  in  order  that  adhesion  or  union  by  the  first  inten- 
tion might  be  accomplished. 

Jan.  ISth. — Patient  has  passed  a  good  night;  slight  acceleration  of  the 
pulse,  but  no  fever;  not  much  thirst,  complains  of  stiffness  in  the  neck,  and 
pain  in  the  back  from  lying  in  one  position  so  long.  Slight  headache  from 
the  anodyne  which  it  was  deemed  advisable  to  administer  before  the  opera- 
tion. 

nth. — Much  as  yesterday;  a  little  nervous,  but  no  fever,  no  swelling  or 
pain  in  the  wound;  some  thirst  and  hunger,  but  willing  to  go  another  day 
without  sustenance. 

15//i. — A  little  feverish;  wound  painful  at  one  point,  thirst  intense,  bow- 
els not  opened;  restless,  and  anxious;  ordered  an  enema  to  be  administered 
at  once;  and  spoonfuls  of  cool  barley  water  to  be  taken  every  hour  or  two. 

IQth. — Much  better;  enema  operated  well,  fever  gone;  thirst  less,  skin 
moist;  cheerful  and  in  hope. 

I7th. — The  same;  took  off  straps  and  found  the  wound  united  along  the 
edges,  with  the  exception  of  here  and  there  a  point;  a  small  pouch  of  pus 
at  the  most  dependent  part  of  the  flap;  patient  rather  restless  under  the 
dressing. 

Evacuated  the  pus  through  a  small  opening  in  its  vicinity;  took  out  some 
of  the  pins,  reapplied  the  straps;  dressed  the  shoulder  with  poultice  of  slip- 
pery elm;  ordered  a  little  mutton  broth,  and  an  enema  of  salt  and  water. 

It  would  be  worse  than  needless  to  detail  the  daily  symptoms  and  treat- 
ment from  this  time  to  the  period  at  which  the  patient  was  enabled  to  move 
about,  and  enjoy  the  full  benefit  of  the  operation. 

It  will  be  sufficient  to  state  that  no  unfavourable  symptom  made  its  appear- 
ance, that  union  by  the  first  intention  took  place  throughout  the  entire 
wound  with  the  exception  of  one  small  point  which  united  by  granulation, 
that  the  wound  in  the  shoulder,  except  just  over  the  acromion  process, 
healed  kindly;  and  that  the  patient,  as  her  own  words  will  testify,  has  been 
relieved  of  all  or  nearly  all  inconvenience.  The  following  extract  is  from 
a  letter  received  some  time  since. 

*'  The  comfort  and  satisfaction  I  feel,  cannot  be  expressed;  your  exertions 


70 


Mutter's  Cases  of  Deformity  from  Burns. 


[July 


in  my  behalf  have  been  blessed  far  beyond  my  most  sanguine  expectations. 
You  have  set  my  head  at  liberty,  so  that  I  can  turn  it  any  ivay,  at  plea- 
sure, and  without  pain;  you  have  relieved  tlie  drawing  of  my  eye;  and 
I  am  also  enabled  to  close  my  mouth  with  comfort,  a  blessing  that  cannot  be 
described!" 

In  order  to  accomplish  the  closure  of  the  mouth,  the  lower  incisor  teeth 
were  straightened  and  one  of  them  extracted  by  a  dentist.  The  angles  of 
the  lower  jaw  have,  in  consequence  of  the  change  in  the  condition  of  the 
throat,  regained  in  a  great  measure  their  proper  shape,  and  the  whole  ap- 
pearance of  the  patient  is  so  much  altered  that  persons  who  saw  her  before 
the  operation,  scarcely  recognize  her  as  the  same  individual.  I  should  have 
mentioned  that  one  troublesome  circumstance  occurred  which  will  serve  as  a 
lesson  in  all  subsequent  operations  of  a  similar  character.  Although  very 
careful  to  extend  my  incisions  from  beyond  what  I  supposed  was  the  extent 
of  the  cicatrix,  I  yet  left  a  band  of  this  tissue,  certainly  not  thicker  or  wider 
than  a  small  wire.  This  band  contracted,  and  before  the  patient  could  be 
entirely  relieved  I  was  obliged  to  loosen  it  by  making  an  incision  in  the 
sound  skin  below  on  the  neck. 

To  support  the  neck  after  the  incision  had  healed,  I  gave  the  patient 
a  stiff  stock  on  which  her  chin  rested,  and  this  instrument  also  served  to 
press  the  integuments  back,  by  which  the  natural  excavation  or  depth  of  the 

neck  in    front  was  readily 


{Tig.  4.) 


effected.  This  stock  is  of 
course  no  longer  in  use,  and 
the  motions  of  the  head 
are  perfect;  although  it  was 
predicted  that  the  antago- 
nism between  the  muscles 
on  the  front  and  back  of  the 
neck  having  been  in  a  great 
degree  destroyed  by  the  sec- 
tion of  the  mastoids,  these 
motions  would  necessarily 
never  be  acquired.  (Fig. 
4,  represents  her  as  cured.) 
More  than  a  twelvemonth 
has  elapsed  since  the  ope- 
ration was  performed,  and 
yet  there  is  no  contrac- 
tion in  the  flap,  and  the 
relief  of  the  patient  is  com- 
plete. 


1842.] 


Mutter's  Cases  of  Deformity  from  Burns. 


71 


Case  II.  In  the  month  of  June  1841,  I  was  requested  to  visit  Margaret 
Ann  Henderson,  aged  12  years,  who  when  four  years  ohl  had  received  a 
severe  burn  of  the  chest,  throat,  and  lower  part  of  the  cheek  from  her  clothes 
having  taken  fire. 


(Fig:.  5.) 


For  nearly  eight 
years  she  had  been  una- 
ble to  turn  her  head  to 
the  left  side,  the  lower 
lip  was  everted,  and  the 
chin  drawn  down  nearly 
n  contact  with  the  ster- 
num, while  the  front  of 
the  throat  presented  the 
rough,  reddish  cicatrix 
represented  in  fig  5. 

This  case    was  even 
more  unfavourable  than 
that  of  Miss  A.  T.;  but 
till,  with   the  view  of 
rendering  her  condition 
somewhat    more    bear- 
able,  I    determined    to 
perform    the   operation 
which  had  proved  so  suc- 
cessful in  the  latter  case, 
but  a  few  weeks  be- 
fore; and  accordingly 
on  the  20th  instant, 
assisted     by       Drs. 
Knox,      Davis,    E. 
Smith,  and  Marston, 
it   was    carried  into 
execution.     The  op- 
erations were  almost 
identical,    with     the 
exception  that  in  the 
case  of  Miss  Hender- 
son the  section  of  the 
tendon  of  the  sterno- 
cleido-mastoid  on  the 
right  side  only,  was 
sufficient  to  allow  the 
head    to    assume    its 
natural  position. 


72 


Mutter's  Cases  of  Deformity  from  Burns. 


[July 


The  after  treatment  was  also  the  same,  nor  did  any  symptom  calling  for 
energetic  measures  make  its  appearance;  all  speaking,  swallowing,  or  motions 
of  the  neck  of  any  kind,  were  carefully  avoided  until  the  fourth  day,  when 
the  pins  were  taken  out,  and  the  patient  allowed  animal  broths.  Fig.  6, 
represents  her  appearance  five  weeks  after  the  operation,  and  up  to  the  pre- 
sent date,  March  21,  she  continues  as  well  as  at  that  period — the  relief 
afTorded  is  therefore  as  permanent  as  it  is  decided. 


Case  III.  About  the  first  of  January  1842,  I  was  requested  to  attend 
Charles  McAlister,  aged  9  years,  for  a  deformity  of  the  mouth  and  throat 
produced  by  a  burn.  As  is  generally  the  case,  the  injury  was  the  result  of 
his  clothes  having  accidentally  taken  fire,  and  he  had  suffered  from  its  incon- 
veniences for  several  years. 

Fig.  7.  The    appearance    pre- 

sented by  this  boy  is  well 
shown  in  fig.  7.  His 
mouth  was  kept  perma- 
nently open,  -^his  incisor 
teeth  were  losing  their 
perpendicular  position,  his 
chin  was  drawn  to  within 
an  inch  or  two  of  the 
sternum,  and  a  strong 
band  of  the  "  tissue  of  the 
cicatrix,"  passed  along 
the  centre  of  the  throat 
from  the  chin  to  the  ster- 
num. The  motions  of 
his  head  were  of  course 
very  much  impaired. 
The  operation  already  de- 
scribed was  performed  be- 
ifore  the  medical  class  on 
the  second  Wednesday  in  January,  and  on  the  first  Wednesday  in  February 
he  was  brought  into  the  amphitheatre  with  scarcely  a  vestige  of  the  deformity 
remaining,  and  the  wound  healed  throughout  with  the  exception  of  a  small 
spot  near  the  shoulder  from  which  the  flap  had  been  removed,  and  which 
united  by  granulation.  It  was  found  unnecessary  to  divide  the  sterno-cleido- 
mastoid  on  either  side.  Here,  in  three  iveeks  time,  a  cure  of  a  deformity 
hitherto  considered  hopeless,  was  effected,  and  during  the  whole  treatment 
not  a  symptom  calculated  to  excite  the  shghtest  anxiety,  made  its  appearance. 
It  may  be  as  well  to  remark  that  I  had  seen  this  boy  several  months  before 
I  had  devised  my  operation,  in  consultation  with  a  professional  friend,  and 
we  both  agreed  in  the  opinion  that  the  best  operation  was  that  in  which  an 


1842.] 


Mutter's  Cases  of  Deformity  from  Burns. 


73 


attempt  is  made  to  loosen  the  cicatrix  by  making  incisions  in  the  adjacent 
Fig.  8.  sound   skin,  and  then 

dissecting  up  the  cica- 
trix itself  and  separat- 
ing the  edges  of  the 
wound  in  the  sound 
part,  allow  the  latter 
to  heal  by  granulation. 
In  other  words,  the 
operation  in  which  the 
tissue  of  the  cicatrix  is 
displaced  from  its  na- 
tural position  and  made 
to  form  adhesions  with 
new  parts. 

Although  performed 
with  the  usual  skill 
and  accuracy  of  the 
accomplished  surgeon 
under  whose  care  the 
boy   was    placed,    the 

operation  failed,  producing,  it  is  true,  some  little  relief,  but  leaving  him  in 

the  condition  described. 

A  fourth  case  of  this  deformity  has  been  treated,  and  with  success,  but  as 

it  resembles  the  others  in  almost  every  respect,  it  is  needless  to  enter  into  its 

details. 


JRemarks. — Few  subjects  in  surgery  have  excited  more  interest  than  the 
peculiarities  of  cicatrices  resulting  from  burns,  and  the  plans  of  treatment  by 
which  the  deformities  they  occasion  may  be  either  alleviated  or  entirely 
removed.  Much  of  the  controversy  originating  in  the  different  views  promul- 
gated, may  be  traced  to  the  fact  that  few  have  studied  the  subject  in  a  pro- 
per manner;  and  great  credit  is  due  to  Dupuytren,  Delpech,  Velpeau  and 
Cooper,  for  the  highly  interesting,  simple,  and  practical  matter  recently  fur- 
nished by  them — by  the  aid  of  which  the  confusion  hitherto  enveloping  the 
pathology  of  this  important  lesion  has  been  removed.  In  the  investigation 
of  this  subject,  with  the  view  of  determining  the  propriety  of  operations  such 
as  those  reported,  it  is  important  to  direct  our  attention  to  several  points. 

1.  The  nature  of  the  tissue  to  be  divided  or  removed. — Although  the 
*'  tissue  of  the  cicatrix,''''  as  it  is  termed  by  Dupuytren,  however  produced, 
always  presents  certain  characteristic  peculiarities  by  which  it  may  be  distin- 
guished from  any  healthy  or  natural  structure,  it  yet  exhibits  modifications 
induced  either  by  the  cause  or  the  tissue  involved.  The  cicatrix  of  a  burn, 
for  example,  can  always  be  readily  distinguished  from  that  caused  by  sharp 
No.  VII.—JuLY,  1842.  7 


74  Mvittev^s  Cases  of  Deformity  from  Burns.  U^^Y 

instruments;  and  again  both  these  from  those  resulting  from  cancers,  ulcers, 
herpetic  diseases,  syphilis  or  scrofula.  The  cicatrix  of  an  ulcer  in  mucous 
membrane,  differs,  too,  from  one  taking  place  in  the  skin. 

Nearly  all  formations  of  this  tissue,  however,  when  dissected,  present  pretty 
much  the  same  structure.  We  have  in  the  first  place  a  delicate  cuticle, 
which  may  be  detached  by  vesication  or  maceration.  Beneath  this  inorganic 
tissue  is  a  dense  stratum  composed  of  strong  fibres,  which  cross  each  other 
at  different  angles,  and  are  firmly  bound  together.  This  is  the  true  "  tissue 
of  the  cicatrix"  of  Dupuytren,  and  the  "inodular  tissue"  of  Delpech,  be- 
tween which  and  the  cuticle  there  is  no  deposite,  as  a  general  rule,  of  rete 
mucosum;  hence  the  whiteness  of  cicatrices  in  the  African.  It  contains  no 
hair  bulbs,  nor  sebaceous  follicles,  at  least  when  the  lesion  is  profound,  and 
although  furnished  with  both  nerves  and  blood-vessels,  is  usually  less  per- 
fectly organized  than  the  parts  whose  loss  it  supplies. 

Lying  under  this  tissue  we  find  a  dense  laminated  substance  composed  of  the 
original  cellular  substance,  which  binds  the  cicatrix  down,  and  offers  in  many 
cases  the  chief  obstacle  to  the  success  of  our  operations.  This  is  especially  the 
case  in  severe  burns;  and  whenever  such  adhesions  exist,  we  must  anticipate 
and  be  prepared  for  most  extensive  dissection  if  an  operation  be  attempted. 

Anotlier  difficulty  occasionally,  though  very  rarely,  presents  itself  in  cases 
dependent  upon  burns — namely,  the  vascularity  of  the  cicatrix.  Whenever 
this  tissue  is  red,  sensitive,  soft,  and  movable,  we  may  fear  hemorrhage; 
and  this  condition  will  therefore  always  render  our  prognosis,  so  far  as 
loss  of  blood  is  concerned,  more  unfavourable  than  when  the  parts  are  pale, 
firm,  inelastic,  and  adherent. 

2.  The  thickness  or  profundity  of  the  cicatrix. — The  depth  to  which 
the  ulcer  upon  which  the  formation  of  the  cicatrix  is  dependent  extends, 
should  always  be  considered  in  our  investigation  of  the  cas€,  for  the  prog- 
nosis, iis  well  as  the  treatment  turn  chiefly  upon  this  point. 

When  the  integument  merely  is  involved,  the  cicatrix  is  for  the  most  part 
elevated,  thrown  into  bands,  movable  and  soft,  the  fascia  beneath  not  being 
contracted.  The  motions  of  the  subjacent  parts  are  also  normal;  and  hence, 
although  the  deformity  may  be  considerable,  yet  the  positive  inconvenience 
is  comparatively  slight.  In  such  a  case  the  prognosis  is  favourable,  and 
the  operation  required  much  less  severe  than  under  other  circumstances. 
When,  on  the  other  hand,  not  only  the  integument,  but  the  superficial  fascia, 
cellular  tissue,  and  muscles  are  attached,  the  inodular  tissue  is  irregular, 
dense,  thrown  into  hard  ridges,  immovable  or  nearly  so,  and  the  parts  which 
it  unites  are  disturbed,  displaced,  or,  as  in  the  case  of  openings  and  cavities, 
obliterated,  the  prognosis  is  very  unfavourable,  and  the  operations  indi- 
cated e;xtensive  and  severe.  This  condition  must  not  be  confounded  with 
that  contraction  of  the  fascia  superficialis  sometimes  accompanying  cutane- 
ous burns,  but  often  the  result  of  other  causes,  many  of  which  are  inappre- 
ciable. For  example,  I  have  known  the  fascia  of  the  palm  of  the  hand  gradu- 
ally harden,  contract,  become  thicker,  and  eventually  inelastic,  thus  causing  a 


1842.]  Wiiiex's  Cases  of  Deformity  from  Burns,  75 

permanent  closure  of  the  hand,  the  skin  covering  it  being  perfectly  soft  and 
pliable,  while  the  cause  of  this  change  of  structure  was  too  subtile  to  admit  of 
detection.     Certain  varieties  of  club  foot  are  produced  in  the  same  way. 

This  contraction  is  also  frequently  brought  about  by  keeping  a  part  too 
long  in  one  position,  and  it  may  result  from  chronic  inflammation  of  parts 
either  above  or  below  the  fascia. 

3.  Location  of  cicatrix. — The  location  of  the  cicatrices  will  also  mo- 
dify the  prognosis  and  treatment.  When  vital  or  highly  organized  regions 
are  involved,  great  caution  must  be  exercised  in  the  delivery  of  an  opinion 
favourable  to  any  attempt  at  relief  by  an  operation;  and  when  such  a  pro- 
cedure is  deemed  advisable,  we  should  always  warn  our  patient,  as  well  as 
his  friends,  of  the  probable  risk.  In  deep  cicatrices  of  such  parts,  there  is 
less  danger  of  hemorrhage  than  one  would  imagine,  and  for  the  reason  that 
during  the  inflammation  which  accompanied  or  preceded  the  healing  of  the 
ulcer,  the  blood-vessels,  especially  the  veins,  in  the  vicinity  were  obliterated 
and  converted  into  fibrous  cords;  but  we  should  always  be  prepared  for  some 
bleeding,  as  all  the  vessels  are  not  included  in  this  obliteration. 

4.  Extent  of  cicatrix. -^The  extent,  too,  of  the  cicatrix  is  a  point  deserv- 
ing attention.  The  wider  and  more  extensive  it  is,  the  more  diflicult  will  it 
be  to  efl^ect  its  removal.  And  we  are  hardly  justified  in  the  performance 
of  an  operation,  unless  there  is  an  almost  positive  certainty  of  our  obtaining 
a  less  deformed  cicatrix  than  the  one  we  wish  to  remove. 

Dupuytren  gives  some  very  excellent  advice  relative  to  extensive  operat- 
ing on  cicatrices:  when,  for  instance,  adhesions  between  the  arm  and  thorax, 
or  thigh  and  pelvis  are  to  be  divided,  he  cautions  us  not  to  complete  the 
operation  at  once,  but  to  proceed  by  fractions,  and  let  the  wound  of  one  opera- 
tion heal  before  we  undertake  another.  In  this  way  we  avoid  the  dangerous 
consequences  which  may  follow  so  large  a  wound  as  would  be  requisite  to 
separate  the  parts  at  once.  The  same  rule  is  applicable  to  extensive  callous 
prominences. 

Another  good  rule  is,  to  be  certain,  before  any  operation  is  attempted,  that 
the  limb  retained  in  a  faulty  position  is  not  incapable  of  being  brought  into 
a  better  one;  if  anchylosis,  alterations  of  articular  surfaces,  or  atrophy  of  the 
member  is  present,  no  operation  should  be  attempted. 

5.  .^o-e  of  cicatrix. — The  duration  or  age  of  this  inodular  tissue  must 
also  be  taken  into  account.  The  advice  of  Dupuytren  is,  *'  that  no  opera- 
tion should  be  attempted  until  several  months  or  even  years  have  elapsed 
since  the  healing  of  the  wound!"  He  believes  that  we  run  great  risk  of 
exciting  inflammation  and  ulceration  in  the  part,  and  moreover,  that  inas- 
much as  the  disposition  of  the  cicatrix  to  contract  is  not  lost  for  a  long 
period  after  its  complete  formation,  we  do  no  good  by  an  operation,  which 
may  indeed  excite  in  this  disposition  a  new  energy.  The  older  the  cicatrix, 
then,  according  to  him,  the  better,  so  far  as  an  operation  is  concerned.  This 
advice  is  at  variance  with  that  of  some  other  surgeons,  but  it  is,  nevertheless, 
as  a  general  rule,  the  safest  to  adopt.     Especially  is  this  the  case  where  the 


76  Mniiev's  Cases  of  Deformity  from  Burns,  [July 

inodular  tissue  is  superficial,  and  curable  by  simple  incisions,  followed  by 
extension  and  pressure  sufficient  to  keep  the  edges  of  the  wound  separate 
from  each  other.  There  are  instances,  as  for  example,  where  the  cicatrix 
is  so  situated  as  materially  to  interfere  with  the  comfort  and  convenience  of 
the  patient,  where  it  would  be  proper  to  deviate  from  this  rule,  and  operate 
as  soon  as  possible:  but  these  are  rare  exceptions,  and  do  not  militate  against 
the  correctness  of  the  general  proposition. 

6.  Peculiar  deformity  of  cicatrix. — The  poiver  with  which  these  cica- 
trices sometimes  contract  is  well  known  to  every  surgeon,  but  is  sometimes 
overlooked  in  the  desire  for  an  operation.  Mr.  Earle  has  known  it  suffi- 
cient to  bring  the  shoulders  towards  one  another  by  a  partial  absorption  of 
the  clavicles.  He  mentions  another  case,  in  which  not  only  the  whole  head 
was  bowed  down  towards  the  sternum,  but  the  lower  jaw  curved  downwards, 
so  as  only  to  admit  of  the  last  molar  teeth  coming  in  contact;  the  mouth 
being  kept  permanently  open,  and  the  direction  of  the  incisor  teeth  so  al- 
tered, that  they  projected  nearly  in  a  horizontal  line.  (This  resembles  very 
much  the  deformity  in  my  own  case  No.  1.)  Cruveilhier  mentions  a  case 
in  which  the  carpus  was  luxated  from  the  radius  by  a  cicatrix  on  the  back 
of  the  hand;  and  I  have  in  my  possession  a  similar  specimen,  and  another  has 
been  deposited  in  the  museum  of  Jefferson  College  by  Professor  Pancoast. 

An  almost  endless  list  of  deformities  of  this  kind  might  be  cited,  but  the 
examples  given  are  sufficient;  and  I  need  hardly  add,  that  in  all  such  no 
ordinary  operation  will  prove  of  the  slightest  benefit. 

When,  therefore,  the  original  shape  and  function  of  a  part  have  been  de- 
stroyed, we  should  never  operate  unless  there  is  a  prospect  of  relieving  at 
least  the  deformity.  There  are  cases  in  which  we  must  be  content  with 
this,  while  the  loss  of  the  function  is  an  evil  for  which  there  is  no  remedy. 

Diversified  as  are  the  deformities  from  burns,  Dupuytren  is  of  the  opinion 
that  they  may  all  be  referred  to  five  classes: — 

1.  Those  in  which  the  cicatrix  is  too  narrow. 

2.  Those  in  which  it  is  too  prominent. 

3.  Those  in  which  it  has  formed  extensive  adhesions. 

4.  Those  in  which  a  cavity  has  been  obliterated. 

5.  Those  in  which  organs  or  an  organ  has  been  destroyed. 

This  classification  has  not  been  adopted  by  all,  although  to  a  certain 
extent  it  is  correct. 

Operations. — It  must  be  obvious  that  as  the  cicatrices  present  a  great 
variety  of  shapes,  occupy  different  positions,  and  penetrate  to  different 
depths,  the  operations  for  their  removal  must  be  modified  to  suit  the  case. 

1.  Narroiv  cicatrix — Incision. — Suppose,  for  instance,  the  deformity 
consists  in  the  formation  of  a  narrow  band  of  inodular  tissue,  which  either 
causes  inconvenience  from  the  motion  of  the  parts  being  interfered  with,  or 
from  its  unsightliness — what  operation  is  most  likely  to  relieve  it?  Surgeons 
are  divided  on  this  point.  While  some  recommend  incision  of  the  band,  as 
performed  by  the  ancients,  others  tell  us  that  such  attempts  are  almost,  if 


1842.]  MHiier^s  Cases  of  Deformity  from  Sums,  77 

not  always  useless,  and  what  is  worse,  that  they  even  increase  the  difficulty, 
each  incision  in  cicatrizing,  shortening  the  band  more  and  more.  The  latter 
view,  though  in  the  main  correct,  is  rather  too  exclusive,  for  there  are  many 
examples  of  entire  relief  having  been  obtained  by  incision  and  pressure,  re- 
ported by  Dupuytren,  Velpeau,  Hourmann,  Berard  and  others.  Much 
depends  on  the  duration  of  the  case,  and  the  depth  to  which  the  cicatrix 
extends.  If  of  long  standing,  and  sufficiently  deep  to  involve  the  fascia 
superficialis,  the  probability  is,  that  the  operation  will  fail,  owing,  as  Mr. 
Earle  has  clearly  shown,  to  the  contraction  of  the  muscles  which  thus  ac- 
quire a  new  sphere  of  action,  and  to  the  adhesions  of  the  fascia.  In  recent 
and  superficial  cicatrices,  however,  the  plan  will  answer,  and  in  its  execution 
there  are  three  indications  to  be  observed. 

1.  The  incisions  are  to  be  made  at  several  points,  and  completely  through 
the  tissue;  a  scalpel  or  bistoury  is  the  instrument  to  be  employed. 

2.  The  parts  are  then  to  be  separated  from  each  other,  and  placed  at 
once,  if  supple  and  yielding,  in  their  natural  position;  if  rigid,  a  slow  and 
gradual  extension  is  to  be  kept  up  by  splints  and  bandages  until  our  end  is 
accomplished. 

3.  Extension  is  to  be  kept  up  some  time  after  the  completion  of  the  cica- 
trix, and  if  new  fraena  or  bands  form  they  must  be  divided. 

2.  Prominent  cicatrix — Excision. — When  the  cicatrix  is  too  prominent, 
forming,  as  it  sometimes  does,  a  most  shocking  deformity,  and  often  caus- 
ing neuralgic  pains,  there  are  several  plans  employed  for  its  removal;  and  as 
there  is  rarely  any  unnatural  contraction  of  the  parts  beneath,  the  elevation 
being  almost  entirely  confined  to  the  skin,  all  the  operations  in  use  are  limit- 
ed in  their  extent  to  this  tissue.  The  one  most  to  be  relied  on  is  that  pro- 
posed by  Dupuytren,  in  which  there  are  three  things  to  be  observed. 

1.  The  projecting  point  is  to  be  sliced  off  on  a  level  with  the  skin. 

2.  The  edges  of  the  wound  are  to  be  kept  apart  by  appropriate  machinery. 

3.  The  surface  of  the  wound  is  to  be  frequently  cauterized  with  argent. 
nit.,  so  as  to  keep  it  rather  below  the  level  of  the  integuments. 

Instead  of  slicing  off  the  cicatrix,  others,  as  Higginbottom,  Cleghorn,  &c. 
prefer  the  application  of  a  caustic  by  which  the  prominence  is  sloughed  out. 
The  nit.  of  silver,  the  chloride  of  zinc,  nitric  acid,  and  arsenical  paste  have 
all  been  employed;  but  it  is  obvious  that  this  process  is  more  painful,  more 
tedious,  and  more  likely  to  leave  a  bad  scar,  than  that  recommended  by 
Dupuytren,  and  should  consequently  be  rejected. 

3.  Extensive  adhesions. — When  the  deformity  consists  in  adhesions  by 
which  parts  are  approximated  that  should  remain  separated,  or  others  sepa- 
rated that  should  remain  in  contact,  numerous  operations  have  been  proposed. 

Dupuytren's  practice  was  as  follows: — 

1.  After  having  divided  the  adhesions,  he  dissected  them  freely  to  beyond 
their  origin. 

2.  Then  he  drew  the  parts  asunder. 

•7* 


78 


Mutter's  Cases  of  Deformity  from  Burns, 


[July 


3.  Methodical  and  constant  pressure  was  maintained  on  the  point  whence 
the  cicatrix  must  proceed,  which  is  always  at  the  angle  of  union  of  the 
parts. — [Clin.  Chir.  torn,  ii,  p.  69.) 

This  plan  succeeds  in  some  cases,  but  very  often  fails. 

In  consequence  of  this  operation  so  frequently  failing  in  the  accomplish- 
ment of  a  cure.  Sir  James  Earle,  and  Delpech  of  Montpellier,  revived  the 
operation  of  Hildanus,  which  consists  in — 

1.  Cutting  out  the  cicatrix. 

2.  In  bringing  the  edges  of  the  wound  together  so  as  to  cover  the  raw 
surface  from  which  the  cicatrix  was  removed. 

3.  In  extending  the  part  by  splints  and  bandages,  and  keeping  them  in  this 
condition  while  cicatrization  was  going  on,  and  for  some  weeks  afterwards. 

By  this  plan  the  contraction  takes  place  in  a  lateral  direction,  and  not  in  the 
long  axis  of  the  part  upon  which  it  is  performed,  and  the  cicatrix  is  soft, 
linear,  movable,  and  as  extensible  as  natural  integument.  This  is  a  favourite 
operation  with  Brodie,  James  of  Exeter,  Hodgson,  and  many  others,  and 
whenever  practicable  is  probably  as  good  as  any  that  can  be  devised;  but 
where  the  cicatrix  is  broad,  irregular,  situated  on  the  neck,  or  different  parts 
of  the  face,  it  is  obviously  a  method  altogether  improper. 

I  have  succeeded  by  slightly  modifying  this  operation  in  curing  a  very 
extensive  cicatrix,  involving  the  arm  and  forearm,  by  which  the  whole  mem- 
ber was  rendered  useless.  After  cutting  out  the  cicatrix,  as  advised  by  Hil- 
danus, I  found  it  impossible  to  draw  the  edges  of  the  wound  over  the  raw 
surface,  and  it  at  once  occurred  to  me  that  the  only  method  by  which  I 
could  secure  success  would  be  that  which  I  have  frequently  resorted  to  in 
the  operation  for  cleft  palate,  when  there  was  difficulty  in  approximating 
the  edges  of  the  cleft,  and 
which  consists  in  making 
lateral  incisions  at  some 
distance  from  the  edges  of 
the  tissue  to  be  displaced.* 
Doing  this,  and  then  draw- 
ing the  wound  together,  I 
covered  the  raw  surface  per- 
fectly; and  then  dressing  the 
two  lateral  wounds  with 
warm  water  dressing,  made 
them  unite  by  granulation. 
The  operation  succeeded 
most  beautifully,  and  may 
be  resorted  to  in  many  simi- 
lar cases. 


[This  is  the  same  as  the  urethro-plastic  operation  practised  by  DiefFenbach;  and  of 
which  there  is  a  description  and  figure  in  the  British  and  Foreign  Medical  Review,  for 
April  1839,  p.  413.J 


1842.]  Miiiiex's  Cases  of  Deformity  from  Burns*  79 

A  plan,  the  principle  of  which  was  clearly  recognized  by  Celsus,  has  been 
put  into  execution  by  my  friends,  Drs.  J.  Rhea  Barton,  and  G.  W.  Norris, 
and  also  by  myself,  in  extensive  cicatrices  about  the  neck,  without,  how- 
ever, deriving  much  benefit  from  its  employment.  The  operation  consists 
in — 

1.  Making  an  incision  through  the  integuments  at  some  distance  from  the 
origin  of  the  cicatrix,  in  other  words,  in  perfectly  sound  skin. 

2.  In  dissecting  up  the  skin  and  cicatrix  as  far  as  possible,  without  mak- 
ing any  new  incisions  in  the  skin  itself. 

3.  In  the  separation  of  the  divided  parts,  so  that  the  cicatrix  slides  from 
its  original  position,  leaving  a  raw  surface  to  heal  by  granulation.  The  ope- 
ration is  severe,  and  though  sometimes  useful,  is  not  much  to  be  relied  on  in 
cases  of  extensive  contraction. 

The  operation,  which  of  all  others,  is  most  entitled  to  our  confidence, 
especially  in  cicatrices  of  the  neck,  cheek,  eyelids,  nose,  lip,  is  that  in  which 
"  auto'plasty'''  is  brought  into  service.  In  all  such  operations,  we  are  go- 
verned by  the  same  principles,  and  pretty  much  the  same  mechanical  details. 
They  consist  in, 

1.  Dividing  the  cicatrix  so  as  to  produce  a  raw  surface,  in  some  part  of 
its  extent;  or  cutting  it  out  entirely,  as  proposed  by  Hildanus. 

2.  In  applying  to  this  raw  surface  a  piece  of  healthy  skin  taken  from  the 
neighbouring  parts. 

3.  In  attaching  this  skin  by  suture  to  the  margins  of  the  wound  in  which 
it  is  inserted. 

4.  In  approximating  the  edges  of  the  wound,  from  which  the  skin  has 
been  removed. 

5.  In  separating,  by  appropriate  agents  the  parts  too  closely  approximated, 
and  keeping  them  in  this  condition,  some  time  after  the  flap  has  united. 

6.  In  applying  oleaginous  frictions,  and  motion  to  the  new  made  parts  to 
give  them  flexibility  and  softness. 

Many  shocking  deformities  from  burns  have  been  relieved  by  the  perform- 
ance of  operations  conducted  on  these  principles;  for  example,  the  eyelid, 
the  cheek,  the  nose,  and  the  lip  have  all  been  restored:  but  I  believe  I  may 
claim  the  merit  (if  merit  there  be  in  adapting  an  old  principle  to  a  new  opera- 
tion), of  having  first  performed  an  operation  of  the  kind  for  the  relief  of 
extensive  cicatrices  of  the  throat. 

Mr.  Liston,  whose  surgical  acumen  and  boldness  no  one  will  deny,  dis- 
tinctly states,  in  his  last  edition  of  the  "  Elements  of  Surgery,"  p.  263, 
*'  that  such  defects  are  beyond  the  reach  of  surgery,"  and  gives  a  drawing 
illustrative  of  the  appearance  of  a  person  so  afflicted — which  drawing  is 
almost  a  fac  simile  of  my  case  No.  1.  I  have  also  carefully  examined  nearly 
all  the  modern  works  on  the  subject,  and  find  no  mention  of  such  an  opera- 
tion having  ever  been  performed.     Velpeau,  in  his  "  Medecine  Operatoire," 


80  Peebles'  Case  of  Gun-shot  Wound  of  the  Face.  [J"ly 

article  "  Cicatrices  Vicieuses,"  merely  hints  at  the  possibility  of  such  an 
operation,  but  this  is  all. 

In  very  extensive  cicatrices  of  the  neck,  it  may  be  well  to  modify  the 
operation  so  as  to  take  2.  flap  from  each  side,  by  which  means  we  shall  avoid 
the  risk  of  a  very  large  single  flap. 

4.  Cicatrices  complicated  with  obliteration  of  cavities. — Where  the  cica- 
trix produces  partial  or  complete  obliteration  of  a  natural  opening,  as  the 
mouth,  &;c.  incision  of  the  angles,  and  the  introduction  of  tents  larger 
than  the  natural  opening,  will  occasionally  do  good;  but  for  the  most  part 
all  such  attempts  fail,  and  it  becomes  necessary  to  perform  the  operation  of 
Dieffenbach,  an  account  of  which  I  published  in  the  18th  No.  of  the  Ameri- 
can Journal  of  Medical  Sciences,  for  1836. 

5.  Cicatrices  complicated  ivith  loss  of  organs. — Where  organs  are  en- 
tirely destroyed,  nothing  short  of  a  "  plastic  operation,"  the  aim  of  which 
will  be  the  construction  of  an  organ  as  much  like  the  original  as  possible, 
offers  the  slightest  prospect  of  benefit  to  the  patient. 


Art.  VT. — Case  of  Gun-shot  Wound  of  the  Face,  luith  loss  of  a  greater 
proportion  of  the  Tongue,  and  extensive  lesion  of  the  bony  structure, 
successfully  treated;  together  ivith  an  account  of  interesting  nervous 
Phenomena,  resulting  from  the  injury. — By  J.  F.  Peebles,  M.D., 
Petersburg,  Va. 

In  the  month  of  August,  1840,  Washington  Perkins,  a  middle-aged  man 
of  robust  constitution,  but  intemperate  in  his  habits,  induced  by  a  fit  of  jea- 
lousy to  attempt  self-destruction,  placed  the  muzzle  of  a  fowling-piece, 
charged  with  duck-shot,  immediately  below  and  in  front  of  the  angle  of  his 
right  jaw,  and  discharged  the  gun  with  his  foot. 

I  saw  him  a  few  minutes  after  the  accident;  the  hemorrhage  was  frightful, 
though  he  was  composed  and  sitting  up  in  bed.  Upon  examination  I  found 
an  entire  breach  in  the  inferior  maxillary  bone  at  the  point  where  the  shot 
had  been  received  of  more  than  an  inch  in  length,  involving  the  loss  of  the 
two  lower  molar  teeth.  Passing  obliquely  upwards  through  the  mouth, 
the  tongue  was  torn  across  in  the  line  of  the  shot,  all  the  free  portion  of  it 
with  the  attaching  fraenum,  completely  severed  and  thrown  forward  between 
the  front  teeth.  The  charge  passed  out  through  the  antrum  about  three 
quarters  of  an  inch  below  the  eye,  carrying  with  it  also  the  two  cuspidati 
and  their  alveolar  processes. 

In  addition  to  the  injury  of  the  inferior  maxillary  bone  already  named, 
there  was  a  transverse  fracture  at  the  symphysis.     Owing  to  the  nature  and 


1842.]  Peebles'  Case  of  Gun-shot  Wound  of  the  Face,  81 

peculiar  situation  of  the  injury,  the  means  for  arresting  the  profuse  hemor- 
rhage were  confined  principally  to  rest  in  the  recumbent  posture  and  cold 
applications  to  the  head,  face  and  neck.  But  the  quantity  of  blood  which 
had  found  its  way  into  the  stomach,  and  still  continued  to  trickle  down  the 
throat,  despite  our  efforts  to  prevent  it,  very  much  embarrassed  and  impeded 
their  effects  by  the  frequent  retchings  it  induced.  As  soon  as  fainting  came 
on  however,  firm  coagula  formed  in  the  cavity  of  the  mouth  and  the  orifices 
of  the  wounds,  and  the  hemorrhage  entirely  ceased.  In  this  stale  he  was 
left  for  the  night  with  directions  for  the  diligent  continuance  of  rest  and  the 
cold  applications  to  the  head  and  face. 

During  the  night,  from  the  frequent  gratification  of  his  intense  thirst,  the 
coagula  were  removed,  and  the  bleeding  partially  returned,  but  a  bit  of  ice 
in  the  mouth  controlled  it  until  the  following  morning,  when  all  oozing  was 
promptly  suppressed  by  pledgets  of  lint  soaked  in  a  solution  of  kreasote  ap- 
plied on  the  bleeding  surface. 

His  face  and  wounds  now  presented  the  following  appearances.  His 
mouth,  particularly  the  lower  portion  of  it,  was  drawn  to  the  left  side;  he 
complained  of  feeling  a  notch  in  the  glass  from  which  he  drank,  owing  to 
loss  of  sensation  in  the  right  portion  of  his  lower  lip,  phenomena  which  in- 
dicated lesion  in  the  motor  and  sensitive  nerves  which  supply  the  lower 
portion  of  the  face.  Over  the  inferior  maxillary  bone  where  the  charge  had 
entered  there  was  a  circular  but  jagged  wound  of  over  an  inch  in  circumfer- 
ence, either  way,  extending  up  on  the  neck.  On  introducing  the  finger  the 
fractured  ends  of  the  inferior  maxillary  bone  were  found  to  present  a  remark- 
able peculiarity.  Instead  of  being  shattered,  and  split  or  splintered  as  might 
have  been  expected  from  the  violence  of  the  accident  and  the  nature  of  their 
structure,  the  ends  of  the  bone  were  found  presenting  regular  and  transverse 
surfaces,  as  if  only  that  plug  of  bone  had  been  clearly  removed  which  had 
received  the  violent  charge,  without  material  injury  to  the  adjoining  portion. 
The  osseous  system  of  this  man  had  always  exhibited  evidence  of  remark- 
able fragility.  He  had  suffered  fracture  of  the  thighs  five  different  times, 
and  as  it  is  usual  in  individuals  suffering  from  fragilitas  ossium,  the  bones 
had  in  each  instance  united,  with  but  little  inconvenience,  and  with  remark- 
able facility.  Was  not  the  regularity  and  favourable  nature  of  the  fracture 
to  be  attributed  to  this  condition  of  the  osseous  system,  which,  doubtless, 
was  general? 

The  end  of  the  tongue  was  retracted  and  swollen,  so  as  considerably  to 
impede  deglutition.  The  left  antrum  was  exposed;  whilst  the  external 
wound  above  presented  the  form  of  a  triangular  incision,  with  a  flap  perfectly 
preserved  and  thrown  back.  This  was  now  brought  down,  the  parts  adjust- 
ing themselves  perfectly  together,  and  confined  with  adhesive  plaster. 

The  portion  of  inferior  ^axillary  bone  between  the  symphysis  and  the 
breach  at  the  angle  had  fallen  inwards,  protruding  the  teeth  longitudinally 
into  the  mouth,  and  was  so  loose  and  detached  as  to  occasion  some  thoughts 


82  Peebles'  Case  of  Gun-shot  Wound  of  the  Face,  [July 

of  the  propriety  of  its  immediate  removal.  It  was  however  erected  into  its 
proper  position  and  confined  as  securely  as  the  circumstances  would  permit, 
and  for  the  few  succeeding  days  the  patient  remained  tolerably  comfortable. 
After  this  time  for  the  succeeding  ten  days  alarming  hemorrhage  from  time 
to  time  continued  to  recur,  but  by  the  diligent  continuance  of  cold  applica- 
tions to  the  head  and  face,  together  with  the  topical  application  of  kreasote 
to  the  bleeding  surface  of  the  tongue  and  cheeks,  it  was  checked;  when  he 
ceased  to  suffer  further  annoyance  or  danger  from  this  score.  At  the  end 
of  the  second  week  the  external  wound  over  the  antrum  had  healed  by  the 
first  intention,  and  although  the  antrum  still  remained  exposed,  the  wound 
in  the  superior  maxillary  bone  from  this  time  gave  no  further  inconvenience. 
The  tongue  was  also  well,  and  healthy  granulations  were  shooting  up  in  the 
wound  in  the  right  cheek.  'J'he  detached  piece  of  inferior  maxillary  bone 
became  now  the  most  embarrassing  feature  of  the  case.  As  it  was  not  fast- 
ened at  either  end  it  was  impossible,  such  was  the  state  of  the  external 
wound,  now  to  adopt  any  means  by  which  it  could  steadily  be  held  in  its 
proper  place  a  sufficient  length  of  time  for  union  to  occur;  and  for  up- 
wards of  a  month  the  prospect  of  its  removal,  either  by  necrosis  or  exci- 
sion, was  improbable.  About  the  middle  of  the  second  month,  however,  it 
had  united  at  the  symphysis,  and  at  once  the  health  of  the  patient,  which 
had  been  kept  feeble  by  the  exhausting  discharge  and  irritation  about  the 
mouth,  rapidly  improved. 

From  this  time  the  contraction  of  the  muscles  gradually  approximated  the 
ends  of  the  inferior  maxillary  bones,  and  at  the  termination  of  the  fourth  or 
fifth  month  they  became  united,  and  the  cure  was  complete. 

The  following  is  the  condition  of  the  man's  face  at  this  time.  Consider- 
ing the  great  loss  of  bone,  its  general  contour  is  but  little  altered.  The  in- 
ferior maxillary  bone,  though  somewhat  shortened,  and  with  the  exception  of 
a  slight  protrusion  at  the  point  where  the  union  at  the  symphysis  occurred, 
is  perfect  and  suflnciently  strong  for  the  purposes  of  mastication.  The 
remaining  portion  of  the  tongue,  doubtless  from  the  long  inactivity  of  its 
muscles,  is  atrophied  to  a  mere  membrane.  It  has  well  developed  papillae, 
however,  and  the  taste  still  remains  unimpaired.  It  affords  no  assistance  in 
speech,  or  in  mastication,  (tlie  finger  being  used  in  the  latter  operation  to 
keep  the  material  between  the  teeth,)  but  remains  motionless  on  the  floor  of 
the  mouth.  The  deglutition  is  perfect.  The  membrane  covering  the  ex- 
posed antrum  is  healthy.  The  mouth  is  still  partially  drawn  to  the  left  side, 
and  the  muscles  of  the  lower  part  of  the  right  side  of  the  face  take  no  part 
in  the  expression  of  the  countenance.  During  laughter  they  are  motionless, 
grotesquely  distorting  the  face.  But  as  this  state  of  things  is  confined  to 
the  lower  part  of  the  face,  the  eyelids  and  muscles  on  the  side  of  the  nose 
remaining  unaffected,  it  is  probable  that  the  lesiori^is  confined  to  the  lowest 
branch  of  the  portio  dura  on  the  face.  A  portion  of  the  motor  branch  of 
the  fifth  pair  is  also  complicated  in  the  lesion,  as  the  muscles  of  the  right 
cheek  are  atrophied,  and  flap,  from  a  want  of  consent  between  their  action  and 


1842.]  ^wiioYiS  Cases  of  Inversion  of  the  Uterus.  83 

the  motions  of  the  jaw,  in  such  a  manner  between  the  teeth  as  to  prevent  mas- 
tication on  that  side.  But  the  sensation  has  returned  in  the  lip.  This  occur- 
red soon  after  union  had  begun  at  the  fracture  near  the  symphysis,  proving 
consequently,  that  the  paralysis  which  had  occasioned  the  loss  of  sensation 
was  owing  only  to  the  pressure  exerted  by  the  displacement  of  bone,  on  the 
branch  of  the  third  division  of  the  fifth  pair  of  nerves,  which  emerges  from 
the  anterior  mental  foramen  to  be  distributed  on  the  lip.  This  man  has  re- 
turned to  his  old  habits,  and  is  frequently  seen  intoxicated  about  the  streets, 
yet  the  bones  of  the  face  and  the  mucous  membrane  of  the  mouth  continue 
perfectly  healthy.  Indeed  the  whole  history  of  the  case  manifests  a  hardi- 
hood, and  a  strong  disposition  to  the  healthy  reparation  of  injury  in  the 
osseous  system  which,  I  think,  is  quite  remarkable. 
Petersburg,  March  22,  1842. 


Art.  VII. — Tioo  Cases  of  Inversion  of  the  Uterus.     By  W.  L.  Sutton, 
M.D.,  of  Georgetown,  Ky. 

Case  I. — Nov.   I6th,  1823. — I  was  desired  to  visit   Mrs.  S.,  who  was 

said  to  be  in  labour.    When  I  entered  the  room,  the  midwife  observed  there 

was  something  wrong.     Upon  making  examination,  the  first  thing  which 

attracted  my  attention  was  a  tumour,  which  from  its  size  and  firmness,  I,  for 

an  instant,  took  to  be  the  head  of  a  child;  and  supposing  the  shoulders  had 

engaged  the  pelvis  unfavourably,  I  ran  my  finger  up  the  neck  to  liberate 

them;  when  I  found  that  this  tumour  was  a  part  of  the  mother,  and  nothing 

less  than  the  uterus  inverted  and  expelled.     I  now  first  learned  that  the  child 

had  been  born.     The  midwife  assured  me  that  she  did  not  have  a  worse 

time  than  common;  that  the  placenta  came  away  in  good  time,  and  without 

difficulty;  that  the  tumour  followed  it  closely;  and  that  not  knowing  what  it 

was,  she  did  not  know  whether  to  permit  its  exit  or  not.     I  endeavoured  to 

replace  it  by  grasping  it  between  my  hands,  and  after  squeezing  it  for  some 

time,  pushing  it  in  the  direction  of  the  outlet  of  the  pelvis.     But  the  tumour 

was  so  firm  that  little  impression  could  be  made  upon  it,  and  I  was  utterly 

unable    to  reduce  it.      Upon    squeezing  the   uterus    several   blood-vessels 

spouted  and  bled  for  a  short  time.     The  patient  had  a  ghastly  aspect;  lips 

bluish,  pupils  dilated,  pulse  very  weak;  yet  the  hemorrhage  had  not  been 

considerable.     She  did  not  complain  much;  but  I  thought  that  was  owing  to 

her  diminution  of  sensibility.     Having  become  entirely  satisfied  that  longer 

endeavours  to  replace  the  uterus  would  be  fruitless,  and  must  still  hasten  her 

dissolution,  I  desisted,  and  attempted  to  sustain  her  by   stimuli  small  in 

quantity,  and  frequently  repeated.     In  this  also  I  failed.     Her  pulse  soon 

disappeared,  and  she  died  in  about  three  hours.     This  woman  was  said  to 

be  somewhat  loose  in  her  morals;  had  conceived  three  times,  and  miscarried 

once;  at  which  time  she  was  said  to  have  had  a  prolapsus  uteri. 


84  Sutton's  Cases  of  Inversion  of  the  Uterus.  [J"ly 

Case  II.— Oct.  I9th,  1835.— Mrs.  H.  in  labour  with  her  first  child— 
the  uterus  being  expelled  with  the  child.  I  saw  her  perhaps  in  half  an  hour. 
The  placenta  was  yet  partially  attached  to  the  fundus  uteri;  the  body  of  the 
uterus  completely  expelled  the  vulva;  no  hemorrhage,  great  sinking,  lips  and 
countenance  livid,  pulse  scarcely  perceptible — the  uterus  not  firm  as  in  case 
1st.  Sent  off*  for  Dr.  Richardson — separated  the  placenta  and  returned,  by 
moderate  and  continued  pressure,  the  uterus  into  the  pelvis.  Dr.  Richardson 
arriving  some  time  afterwards,  completed  the  reduction.  She  continued  very 
weak  and  faint,  and  had  frequent  retching.  This  state  was  considerably  al- 
leviated by  injections  of  starch  and  laudanum.  In  this  case,  the  membranes 
gave  way  several  hours  before  the  child  was  born,  the  presentation  natural, 
pains  rather  short  and  at  considerable  intervals.  The  body  was  not  expelled 
by  the  same  pain  which  expelled  the  head;  but  the  uterus  followed  the  body 
by  the  same  pain;  the  cord  was  rather  short. 

Evening. — She  has  taken  small  doses  of  stimuli  during  the  day;  also  a 
dose  of  ol.  ricini,  which  vomited  her.  Complains  of  great  soreness,  pulse 
weak  and  very  quick,  lochia  proper;  has  passed  no  urine,  nor  felt  any  dis- 
position to  do  so. 

"Zath. — 3  o'clock,  A.  M.  A  great  deal  of  pain  in  the  uterine  region — has 
passed  no  urine  or  feces,  or  feels  any  disposition  to  do  so;  pulse  small,  some- 
what hard  and  very  frequent,  severe  headache.  Drew  off  about  three  pints 
of  urine:  bled  to^viii — cold  water  to  head,  ol.  ricini  ^ii.  Evening. — Medicine 
operated  well:  dejections  said  to  be  proper,  pulse  still  frequent  (about  150,) 
headache  undiminished,  no  abdominal  pain,  lochia  have  been  rather  profuse, 
but  at  present  proper.  Sinapisms  which  have  been  appHed  to  the  head,  hav- 
ing failed  to  give  relief,  a  blister  was  applied  to  the  back  of  the  neck;  lauda- 
num gtt.  x.  to  restrain  the  operation  of  the  oil;  discharge  of  urine  natural. 

21s/.— -Head  still  aches;  pulse  132;  bowels  freely  open;  urine  plenty; 
lochia  proper;  no  milk.  Blister  drew  well  without  materially  relieving  the 
head. 

226/.— 'Head  still  aches,  skin  pleasant;  pulse  132;  no  milk;  lochia  offensive 
and  pale.  R*  Draw  the  breasts,  and  wash  the  vulva  and  vagina  with  chamo- 
mile tea. 

23^.— Head  somewhat  relieved;  skin  pleasant;  pulse  132;  some  appetite; 
no  milk;  urine  scant;  lochia  offensive;  bowels  have  not  been  moved  for  36 
hours:  a  little  tenderness  in  the  uterine  region.  B.  Injection  of  chamomile 
tea  into  the  uterus  and  vagina:  Seidlitz  powders  to  keep  the  bowels  regular. 

25/A. — The  head  has  nearly  ceased  to  ache,  but  feels  very  sore.  The 
injections  into  the  uterus  appear  to  have  benefited  her  much.  No  fetor 
attends  the  lochia:  feels  comfortable;  skin  natural;  bowels  in  good  order;  no 
milk,  but  some  soreness  of  the  breasts.  From  this  time  she  continued  to 
improve,  but  her  health  remained  delicate  for  some  time.  She  never  had 
any  secretion  of  milk.  In  the  management  of  this  case  I  had  the  benefit  of 
Dr.  Richardson's  advice,  who  saw  her  twice  with  me  after  the  reduction  was 
effected. 


1842.]  Jb.xVis's  Case  of  Extravasation  of  Blood,  85 


Art.  VIII. — Case  of  Extravasation  of  Blood  into  the  cellular  texture, 
beneath  the  shin  of  the  Penis. — By  Edwarb  Jarvis,  M.D.,  Louisville, 
Kentucky. 

Jan.  \4:th,  1841. — A  thin  healthy  man,  of  the  age  of  27,  while  in  coitu, 
and  just  before  the  orgasm,  felt  something  give  way  in  the  penis.  Never- 
theless, the  orgasm  followed,  and  the  seminal  fluid  was  ejected,  but  without 
the  usual  excitement.  The  organ  was  at  once  relaxed,  but  swollen  and  dis- 
coloured. He  walked  about  half  a  mile,  feeling  a  slight  pain,  and  an 
increasing  heaviness  and  fulness  in  the  penis. 

I  saw  the  patient  in  half  an  hour  after  the  accident,  and  found  the 
penis  very  much  distended  with  venous  blood,  along  the  dorsum  and  the 
left  side  and  around  the  prepuce.  The  diameter  of  the  organ  was  greater 
than  in  the  state  of  erection.  On  the  right  side,  from  one  inch  below  the 
corona  glandis  to  near  the  pubes,  there  was  neither  swelling  nor  discolora- 
tion; and  here  was  a  curve  occasioned  by  the  great  distension  of  the  oppo- 
site side.  The  swelling  encircled  the  whole  body  of  the  penis  at  its  root, 
and  at  the  prepuce;  and  at  the  latter  place  the  distension  of  the  integument 
was  greater  than  in  any  other  part.  There  was  neither  pain  nor  tender- 
ness, nor  difficulty  in  micturition. 

Three  years  previous  to  this  accident,  the  patient  had  worn  a  very  tight 
pair  of  pantaloons,  the  middle  seam  of  which  pressed  so  closely  upon  the 
left  side  of  the  penis,  where  it  curved  to  lie  upon  the  opposite  thigh,  as  to 
cause  much  pain  and  tenderness  at  that  spot,  and  especially  at  the  time  of 
erection.  These  symptoms,  and  a'  local  weakness  never  left  him.  It  was 
precisely  at  this  spot,  that  the  rupture  of  the  sheath  of  the  corpus  caverno- 
sum,  appeared  to  be — and  on  this  point  alone,  was  any  tenderness  felt  upon 
pressure. 

The  extravasion  was  still  going  on,  and  the  purple  swelling  increasing.  I 
therefore  directed  absolute  rest  upon  the  back;  application  of  lead-water  to 
the  swelling,  without  covering  of  bed-clothes  over  the  hips  and  pubes. 

In  one  hour  found  the  swelling  somewhat  greater,  but  the  rapidity  of  its 
increase  checked.  Not  wishing  to  open  the  skin  while  the  hemorrhage  was 
active,  I  ordered  a  solution  of  mur.  amnion,  in  spirits  and  water  equal  parts, 
perfect  rest,  and  cold  for  the  night. 

15^/i. — Hemorrhage  arrested;  coagulation  taking  place;  opened  the  skin 
with  a  bistoury,  making  a  free  incision  longitudinally  along  the  dorsum,  and 
transversely  through  the  prepuce  on  the  right  side.  The  blood  oozed  out, 
but  the  cellular  substance  was  filled  with  coagula;  directed  the  continued 
application  of  towels  dipped  in  hot  water,  and  the  whole  to  be  kept  covered 
with  blankets,  to  retain  the  heat,  and  promote  the  discharge  of  blood. 

At  night,  the  blood  had  oozed  freely  from  the  incisions,  and  the  swelling 
No.  VH.—JuLY,  1842.  8 


86  Jarvis's  Case  of  Extravasation  of  Blood.  [July 

was  diminished  along  the  dorsum,  and  on  the  right  side  of  the  prepuce. 
Made  another  incision  on  the  left  of  the  prepuce;  continued  hot  applications 
for  the  night. 

\Qth. — Swelling  diminished;  though  not  so  much  on  the  left  side  of  the 
dorsum  or  elsewhere;  made  an  incision  on  this  side;  continued  applications 
of  warm  water. 

\lth. — Blood  ceased  to  flow  through  the  incisions,  and  these  were  healing. 
Supposing  the  rest  of  the  coagula  might  be  absorbed,  I  changed  the  hot  to 
cold  applications,  and  ordered  the  solution  of  ammonia,  first  covering  the 
wounds  with  simple  cerate,  to  defend  them  from  the  irritation  of  the  am- 
monia. Gave  also,  submur.  hyd.  gr.  vj,  aloes  gr.  iv;  comp.  ext.  colocynth 
gr.  iii,  M.,  which  produced  a  small  operation. 

\^th. — Absorption  going  on;  swelhng  diminishing.  Bowels  costive;  gave 
sulph.  magnes.  ^i;  continued  cold  lotions. 

\9th. — Swelling  about  the  dorsum  penis  changing  from  the  purple  to  yel- 
lowish hue;  continued  lotions.  Gave  him  jalap  pulv.  gr.  x,  supertart. 
potass,  gr.  xii,  M.  Noon,  no  operation;  much  nausea;  gave  sulph.  magnes. 
ji.     Evening;  vomited  in  afternoon;  very  feeble;  absorption  rapid. 

20/A. — Had  four  operations  in  night;  with  great  nausea,  yellowness  of 
skin  extending.     Continued  lotions. 

2\st. — One  operation;  swelling  diminishing;  organ  nearer  the  natural 
shape  and  size.     Corpus  cavernosum  feels  somewhat  distended,  and  hard. 

Patient  has  been,  for  many  years,  troubled  with  night  erections,  which 
have  latterly  increased.  He  had  these,  on  the  night  both  of  the  20th  and  21st. 
Then  felt  the  pain,  at  the  point  where  the  sheath  appeared  to  be  ruptured. 
This  erection  was  immediately  relieved  by  the  cold  lotion. 

22c?. — Improving;  swelling  in  cellular  tissue  diminished.  .  Skin  more 
pale;  corpus  cavernosum  hard  as  yesterday.  Bowels  costive;  gave  sulph. 
magnes.  §i.;  lotions  as  before. 

23(/.' — Salts  operated  favourably;  patient  feels  well;  swelling  of  skin 
mostly  gone.  The  purple  hue  much  diminished,  and  the  sallow  colour  ex- 
tending. Corpus  cavernosum  somewhat  hard  and  distended;  penis  not  per- 
fectly relaxed,  and  flaccid  as  natural;  no  pain,  but  a  little  tenderness  at  the 
point  of  rupture. 

In  all  this  time,  there  was  no  difficulty  in  micturition;  no  excitement,  nor 
irritation  nor  heat  in  the  body  of  the  penis.  Patient  lay  on  his  back  until 
the  20th,  confined  himself  strictly  to  vegetable  diet,  and  cool  drinks;  where- 
by all  inflammation  was  prevented. 

At  9  o'clock  this  morning,  he  started  on  a  journey  of  two  days,  in  the 
stage,  over  a  hard  road. 

February  2Qth. — He  wrote  for  advice.  "  I  arrived  safely,  without  any 
pain  or  inconvenience.  I  have  taken  no  medicine,  nor  made  external  appli- 
cations. I  am  better  and  improving,  yet  not  well.  The  penis  is  reduced  to 
its  natural  size,  and  all  discoloration  is  gone;  but  the  part  where  the  rup- 


1842.]  J^xv\s''s  Case  of  Extravasation  of  Blood.  87 

ture  was,  is  not  quite  healed:  and  on  erection,  the  penis  is  bent,  and  drawn 
down  to  one  side,  and  attended  with  considerable  pain;  I  wish  you  to  pre- 
scribe again  for  this  condition  of  things." 

Advised  frictions  with  ung.  hyd.,  moderate  diet,  and  exercise,  and  absence 
of  all  stimulants. 

*Bpril  5fh. — He  again  wrote,  "  I  followed  your  prescription  strictly  as  to 
the  use  of  the  mercurial  ointment.  I  have,  in  a  good  measure,  abstained 
from  warm  and  strong  food,  and  entirely  from  intoxicating  drinks.  The 
pain,  during  erection,  has  much  abated,  but  the  penis,  when  erected,  is  very 
much  bent,  and  when  not  erect,  there  appears  to  be,  in  the  body  of  it,  at  or 
near  the  place  where  the  rupture  occurred,  a  lump  or  hard  substance,  and  al- 
though I  have  rubbed  the  part  regularly,  two  or  three  times  a  day,  I  don't 
think  it  much  diminished." 

Sth. — Advised  cold  douche  and  friction  with  iodine  ointment,  and  the 
camphor  liniment. 

May  lOth. — Patient  wrote,  that  under  the  influence  of  the  cold  douche 
applied  daily,  and  the  iodine  ointment  and  camphor  liniment,  he  was  some- 
what better  than  when  he  wrote  before.  "  But  my  improvement  is  very  slow. 
The  pain,  during  erection,  is  almost  entirely  gone;  but  there  is  still  consi- 
derable chordee;  my  improvement  was  confined  to  the  two  first  weeks  of 
using  the  last  prescription.  Since  that  time  I  have  been,  I  think,  station- 
ary." 

Advised  bandaging  penis;  keeping  this  wet  with  solutions  of  mur.  am- 
monia, and  occasional  frictions  with  ung.  mur.  ammon. 

The  patient  improved  through  the  summer;  but  the  chordee,  the  local  ten- 
derness, and  slight  swelling  and  hardness  at  the  point  of  rupture,  had  not 
entirely  disappeared  in  September,  1841,  when  he  died  of  fever. 


88 


[July 


MEDICAL  EDUCATION  AND  INSTITUTIONS. 


Art.  IX. — On  the  condition  of  the  Profession  on  the  eastern  coast  of 
South  £.merica,  and  the  prevalent  Diseases  of  that  country.  By  H. 
Pleasants,  M.  D.,  of  West  Philadelphia. 

The  following  remarks,  concerning  the  character  and  advantages  of  the 
medical  profession  on  the  eastern  coast  of  South  America,  with  observa- 
tions on  the  diseases  of  that  country,  are  offered  from  a  desire  to  lessen 
the  difficulties  which  exist,  of  obtaining  similar  information  through  other 
sources,  and  a  belief  that  they  may  prove  useful  to  those  junior  members  of 
the  profession,  who  are  in  search  of  a  locality  suitable  for  the  practice  of 
medicine. 

The  great  field  there  ofTered  for  usefulness  and  fortune,  appears  highly 
favourable  to  those  young  men  whose  migratory  disposition,  unrestrained 
by  love  of  home,  or  domestic  ties,  will  facilitate  their  undergoing  voluntary 
exile  amongst  an  irreligious,  ignorant,  and  immoral  people.  The  informa- 
tion which  I  design  to  convey,  has  been  derived  from  frequent  conversa- 
tions with  intelligent  native  and  foreign  gentlemen,  within  and  without  the 
profession;  from  personal  observation  during  a  residence  in  the  country 
in  the  years  1836,  '37,  and  '38;  and  from  subsequent  correspondence  with 
friends  residing  in  those  regions. 

Disturbed  as  the  country  has  been  by  civil  and  foreign  wars  almost  con- 
tinually since  its  original  settlement  by  Europeans,  but  little  progress  has 
been  made  in  the  sciences  by  any  of  the  natives;  with  but  few  exceptions, 
their  distinguished  and  professional  men  are  foreigners,  and  of  those  few, 
by  far  the  greater  part  were  educated  abroad.  To  France,  Spain,  and 
Portugal,  the  inhabitants  are  especially  indebted  for  the  few  men  of  sci- 
ence to  be  found  amongst  them. 

In  the  whole  empire  of  Brazil,  containing  an  extent  of  country  one-third 
greater  than  the  United  States,  with  a  population  over  4,000,000,  includ- 
ing within  its  limits  several  large  cities  containing  from  10,000  to  150,000 
inhabitants,  there  was,  until  the  reign  of  Don  Pedro  I.,  the  greatest  deficit 
of  the  means  of  education.  Previously  to  his  reign,  schools  of  any  kind 
were  rarely  to  be  found  out  of  the  cities,  and  even  a  plain  education  in 
their  native  language  (the  Portuguese)  afforded  grounds  for  an  enviable 
superiority.  The  salutary  efforts  commenced  within  sixteen  years  by 
that  emperor,  to  improve  the  learning  of  Brazil,  the  leading  statesmen  who 
survive  him  have  endeavoured  to  continue;  and  since  his  death  many  use- 
ful laws  upon  the  subject  of  education  have  been  enacted  and  are  now  in 
beneficial  operation.  A  great  amelioration  is  already  visible  in  the  cha- 
racter and  information  of  the  inhabitants,  and  foundations  for  still  greater 
improvement  are  now  laid,  which  promise  to  take  from  Brazil  the  oppro- 
brium of  dependence  upon  imported  learning.  Aware  of  so  great  a  de- 
ficiency of  the  means  of  an  ordinary  education,  we  are  prepared  to  believe 


1842.]  Pleasants  on  Medical  Profession  in  Brazil,  ^c.  89 

jthat  the  higher  branches  of  science  have  been  still  more  neglected;  and 
since  the  efforts  at  amelioration  could  only  affect  them  subseqiienlly  to  a 
reform  in  elementary  education,  that  reform  would  show  its  salutary 
effects  upon  the  sciences  at  a  much  later  period.  Such  indeed  has  been 
the  case,  but  it  behoves  me  to  confine  my  remarks  to  the  department  of 
medicine. 

Previously  to  the  reign  of  Pedro  I.,  so  little  attention  was  paid  to  teach- 
ing medicine  and  surgery,  that  a  good  medical  education  could  not  be  ob- 
tained in  the  country,  and  the  surgeons  ranked  with  and  performed  the 
offices  of  their  equally  learned  barbers. 

A  hospital  had  been  founded  by  a  brotherhood  of  philanthropic  Euro- 
peans, of  the  order  Miserecordia,  at  Rio  de  Janeiro,  as  early  as  1582,  but 
it  appears  during  a  long  period  to  have  been  conducted  upon  very  unsci- 
entific principles.  The  emperor  was  the  means  of  placing  this  institution 
on  a  proper  footing  for  effecting  charitable  purposes,  in  the  most  advan- 
tageous manner,  and  of  improving  a  military  hospital  which  had  been  pre- 
viously located  there. 

These  institutions,  both  useful  and  flourishing,  are  conducted  in  a  man- 
ner highly  creditable  to  the  country.  Having  had  no  opportunity  of  visit- 
ing the  military  hospital,  I  can  say  nothing  of  interest  concerning  it,  but 
from  personal  observation  I  believe  the  Miserecordia  (civil)  hospital  to  be 
surpassed  in  usefulness,  both  to  patients  and  pupils,  by  none  of  the  simi- 
lar institutions  in  our  own  country.  It  is  a  large  two  story,  airy  building, 
erected  in  a  well  ventilated  part  of  the  city,  calculated  to  hold  from  200 
to  300  beds,  supported  by  private  charities  and  the  income  arising  from 
legacies.  The  afflicted,  whosoever  he  may  be,  is  immediately  admitted 
on  application;  sex  is  the  only  distinction;  white  or  black,  bond  or  free, 
have  no  preference  shown  them,  but  are  to  be  found  on  contiguous  beds, 
treated  alike  with  kindness  and  commiseration.  Three  surgeons  and 
two  physicians  have  charge  of  the  institution.  Judicious  clinical  re- 
marks are  regularly  made  to  the  students  in  attendance,  and  on  a  fatal  ter- 
mination, every  facility  is  afforded  for  an  examination  of  the  body,  which 
no  superstitious  feeling  prevents,  even  though  conducted  without  privacy. 

One  of  the  two  physicians  of  this  hospital,  O.  D.  Mirebelles,  an  intelli- 
gent mulatto,  was  one  of  a  number  sent  by  Pedro  I.  to  Europe,  to  receive 
his  medical  education. 

The  different  provinces  are  unable  to  make  laws  upon  the  subject  of  the 
profession,  but  physicians  are  responsible  to  those  passed  by  the  general 
government,  at  Rio  de  Janeiro.  These  are  generally  judicious,  but  in 
many  places  utterly  disregarded.  By  law,  any  person  practising  without 
license,  or  writing  a  prescription  in  any  other  language  than  the  Portu- 
guese, is  subject  to  a  considerable  penalty;  but  my  medical  acquaintances 
and  myself  were  nearly  all  unlicensed,  and  inattentive  to  the  law  relating 
to  prescriptions.  Yet  no  notice  was  at  any  time  taken  of  our  transgres- 
sions. 

Formerly  there  were  appointed  two  examiners  for  the  empire,  one  for 
surgery,  and  one  for  medicine,  whose  duty  it  was  to  examine  all  candi- 
dates wheresoever  educated,  and  grant  or  refuse  a  license  according  to  the 
ability  of  the  applicant:  but  a  system  of  favouritism  having  resulted,  these 
offices  were  abolished,  and  there  are  now  two  institutions  for  medical  in- 
struction, at  either  of  which  any  foreigner  who  presents  satisfactory  evi- 
dence of  having  received  a  regular  medical  education,  may  obtain  a  license 

8* 


90  Medical  Education  and  Institutions.  [j^^^Y 

by  paying  a  certain  fee  and  passing  creditably  an  examination  by  their  re- 
spective i'aculties. 

One  of  these  institutions  is  located  at  Bahia,  in  the  northern  part  of  the 
empire,  of  which  I  have  heard  but  little  favourable;  the  other  is  centrally 
situated  at  the  Capitol  Rio  de  Janeiro,  possessing  great  advantages  for  ob- 
taining a  sound  medical  education.  Here  are  six  professors  engaged  in 
teaching  the  ordinary  branches,  endowed  with  power  to  grant  licenses  to 
practise,  but  not  to  confer  degrees. 

The  requisitions  to  obtain  a  license  are — a  knowledge  of  the  French 
language,  attendance  at  the  institution  during  five  years,  passing  yearly 
examinations  by  each  of  the  professors,  and  a  thorough  final  examination 
by  the  whole  faculty.     A  classical  education  is  not  essential. 

Such  are  now  the  advantages  and  facilities  for  obtaininsr  a  medical  edu- 
cation  in  Brazil,  but  the  short  period  of  their  existence,  has  not  been  suf- 
ficient to  supply  the  great  deficiency. 

We  therefore  find  most  of  the  interior,  and  many  of  the  smaller  cities, 
depending  upon  foreign  countries  for  skilful  practitioners,  and  some  places 
are  still  relying  upon  the  most  ignorant  pretenders. 

Some  of  these  places  I  have  visited,  and  of  others  I  have  received  ac- 
counts to  be  relied  on  from  intelligent  persons. 

In  addition  to  those  places  where  the  physicians  are  ignorant  and  un- 
skilful, many  others  present  openings  to  foreigners,  even  when  supplied 
by  natives.  For  as  might  reasonably  be  expected  amongst  a  people  reared 
under  the  greatest  superstition  and  moral  degradation,  we  find  mutual  envy 
and  distrust,  corresponding  with  a  consciousness  of  their  own  inferiority 
in  moral  virtues.  On  this  account,  therefore,  there  exists  among  afflicted 
natives,  a  prejudice  in  favour  of  foreign  practitioners;  and  furthermore,  the 
continued  civil  broils,  from  which  scarcely  any  province  in  the  empire  is 
exempt,  obliges  the  physicians  and  surgeons,  accordingly  as  they  have 
been  ranked,  to  leave  their  residence,  as  this  or  that  party  is  successful. 
But  the  discreet  foreigner,  protected  by  his  own  country's  authority,  re- 
mains unmolested  to  continue  the  practice  of  his  profession. 

In  connection  with  tiiese  remarks,  applicable  to  the  country  generally, 
a  few  words  relative  to  the  especial  advantages  possessed  by  certain  of  the 
cities  on  the  coast,  of  which  I  have  received  more  particular  information, 
may  not  be  deemed  inappropriate. 

The  city  of  Pernambuco,  containing  about  8000  inhabitants,  having  a 
considerable  number  of  English,  American,  and  other  foreigners,  had,  in 
1837,  no  foreign  physician, 

Rio  de  Janeiro  contains  180,000  inhabitants,  and  though  well  supplied 
by  intelligent  natives,  yet  from  the  numerous  English  and  American  trad-, 
ers  and  residents,  it  offers  considerable  inducements  to  practitioners  from 
their  respective  countries.  The  two  stationed  there,  are  already  old,  and 
liave  realized  fortunes. 

The  beautiful  island  of  St.  Catherines,  adjacent  to  the  rich  province  of 
the  same  name,  of  which  it  is  the  principal  seaport,  though  proverbially 
healthy,  still  sufi'ers  from  those  epidemic  and  endemic  diseases  incident  to 
the  country,  and  from  the  deficiency  of  practitioners,  also  ofiers  great 
advantages. 

Continuing  our  progress  south,  we  find  still  greater  prospects  of  success 
afforded  in  either  of  the  three  large  towns  in  the  province  of  Rio  Grande. 
Though  now  greatly  injured  by  the  civil  war  which  it  has  for  the  last  five 


1842.]  Pleasants  on  Medical  Profession  in  Brazil,  (^-c.  01 

years  been  continuing  against  the  general  government,  this  province  is  one 
of  the  richest  in  Brazil,  and  situated  in  a  higher  southern  latitude,  its  cli- 
mate is  less  oppressive  on  account  of  heat  than  that  of  most  of  the  other 
provinces.  Porte  Alegre,  the  capital,  an  important  place,  situated  200 
miles  from  the  sea,  in  a  romantic  hilly  district,  is  accessible  to  vessels 
drawing  8  to  10  feet  water,  and  has  considerable  foreign  trade,  and  about 
10,000  inhabitants.  Here  was  no  foreign  practitioner,  and  the  supply 
even  of  the  natives  was  insufficient, 

Pelotas,  situated  nearer  the  sea,  on  an  arm  of  the  same  water-course, 
accessible  only  to  small  vessels,  is  in  time  of  peace  a  thriving,  increasing 
place,  containing  about  6000  inhabitants,  most  of  whom,  with  the  neigh- 
bouring residents,  are  either  direcdy  or  indirectly  engaged  in  the  import- 
ant and  lucrative  business  of  raising  and  slaughtering  cattle  for  the  export- 
ation of  hides  and  beef.  Here  three  physicians  were  established  in  large 
practice,  one  ignorant  in  the  extreme  and  unpopular;  another,  a  Scotch- 
man, nearly  overcome  by  intemperance. 

The  city  of  Rio  Grande,  though  inferior  to  the  above,  is  a  seaport  of 
considerable  importance,  situated  near  the  sea  on  a  barren  sand  heap.  It 
contains  generally  6000  inhabitants,  and  has  three  physicians  well  sup- 
ported; but  during  the  war,  the  population  was  increased  one-third,  and 
six  practitioners  were  generally  employed.  Here  a  small  civil  hospital  is 
established  for  the  relief  of  the  afflicted  poor.  It  is  a  well  located,  airy 
stone  building,  calculated  for  about  50  beds,  and  is  under  the  care  of  one 
medical  attendant,  who  receives  a  salary  for  his  services,  but  is  not  denied 
the  advantages  of  private  practice.  Being  familiar  with  the  treatment  there 
pursued,  I  will  briefly  detail  some  few  of  the  many  cases  of  malpractice 
constantly  occurring.  Thus  offering,  by  exposure  of  the  errors  in  this 
hospital,  a  fortiori  evidence  of  the  great  ignorance  of  the  ordinary  coun- 
try practitioners. 

Case  I.  The  subject  of  this  case  was  treated  out  of  the  hospital,  by  the 
surgeon  subsequently  appointed  over  that  institution.  An  English  gentle- 
man, aetat.  30,  of  good  constitution,  received  a  gunshot  wound  above  the 
elbow,  l^acturing  the  humerus,  without  much  laceration  of  the  soft  parts; 
no  attempt  was  made  immediately  to  take  up  the  bleeding  vessels,  or  to 
treat  the  injury  in  a  manner  likely  to  save  the  limb,  but  a  tourniquet 
applied  tightly  around  it,  entirely  stopping  the  circulation,  was  permitted 
thus  to  remain  24  hours.  Mortification  of  the  parts  below,  apparently  the 
result  of  this  ill-judged  treatment,  soon  followed,  for  which  subsequent 
amputation  at  the  shoulder  joint  was  deemed  advisable,  and  wonderful  to 
say,  successfully  performed. 

Case  II.  An  American  sailor  suffering  under  syphilis,  was  discharged 
from  this  institution,  after  long  continued  medication,  as  incurable;  he  was, 
however,  restored  to  health,  in  a  few  weeks,  by  the  judicious  treatment 
recommended  by  an  American  gentleman,  out  of  the  profession. 

Case  III.  A  mulatto  sailor,  from  Baltimore,  aetat.  about  35,  with  good 
general  health,  was  admitted  into  the  same  institution,  suffering  under 
recent  popliteal  aneurism  succeeding  a  blow  upon  the  part.  He  was 
treated  for  several  weeks  with  different  discutient  applications,  without 
any  beneficial  result,  and  finally  was  subjected  to  amputation  of  the  thigh, 


92  Medical  Education  and  Institutions,  [J"b' 

notwithstanding  my  remonstrances  to  the  contrary,  and  recommendation 
of  the  unheard-of  operation  of  tying  the  femoral  artery.  Amputation  was 
performed  in  the  most  unskilful  and  barbarous  manner  it  is  possible  to  con- 
ceive. "  Sugar-loaf  stump"  followed,  apparently  the  result  of  the  length 
of  bone;  and  at  my  final  visit  to  the  hospital,  nearly  three  months  after  the 
operation,  the  surface  of  the  stump  was  still  unhealed,  and  the  patient 
reduced  to  the  last  stage  of  hectic  fever. 

The  medical  practice  pursued  in  this  institution  is  no  less  deserving  of 
censure;  but  though  replete  with  convincing  proofs  of  extreme  and  fatal 
ignorance,  the  limits  assigned  to  this  article  will  forbid  the  details  of  indi- 
vidual cases. 

The  facilities  afforded  by  either  of  the  above  mentioned  locations  for  an 
extensive  practice  being  spoken  of,  it  becomes  proper  to  refer  to  the  pecu- 
niary advantages  to  be  anticipated.  The  fees  for  professional  services  are 
not  estabHshed  by  law,  but  are  generally  regulated  by  the  reputed  wealth 
of  the  individual,  and  where  the  demand  for  payment  is  made  soon  after 
recovery,  whilst  there  is  felt  that  sense  of  gratitude  too  soon  extinguished, 
a  reliance  upon  the  generosity  of  the  individual  is  not  unfrequently  most 
advantageous.  Thus  are  the  largest  fees  often  received:  100,  200,  or  300 
dollars  are  by  no  means  uncommon  remunerations  after  a  short  attendance 
during  severe  illness. 

Where  an  important  operation  is  about  to  be  performed  for  a  rich  per- 
son, it  is  customary  to  arrange  previously  the  compensation,  and  thus  fees 
of  from  $300  to  $500  dollars,  are  occasionally  paid  immediately  for  those 
performed  for  calculus,  cataract,  hernia,  and  other  surgical  diseases. 

Practitioners  in  the  cities  are  frequently  called  upon  to  visit  persons  re- 
siding in  the  adjacent  country,  and  for  such  visits,  to  rich  individuals,  the 
fees  paid  at  the  time  are  always  full,  often  large,  and  occasionally  exceed- 
ingly liberal. 

Physicians  are  never  accustomed,  as  in  the  United  States,  to  wait  a 
definite,  I  had  almost  said  an  indefinite  period,  for  the  amount  of  their 
bills,  but  payment  is  either  ofTered  or  solicited  shortly  after  the  requisitions 
for  their  services  have  ceased. 

In  prosecuting  the  last  division  of  my  subject,  it  is  not  designed  to  pre- 
sent a  full  account  of  the  diseases  incident  to  the  country,  but  merely  to 
designate  in  a  brief  manner  those  which  the  newly  located  practitioner  will 
most  commonly  be  called  on  to  encounter;  thus  affording  him,  by  even  a 
very  superficial  account  of  the  number  and  character  of  the  adversaries 
with  which  he  will  be  obliged  to  contend,  information  which  may  enable 
him  to  make  suitable  preparation  for  the  contest. 

Drawn  chiefly  from  observations  of  diseases  occurring  in  the  southern 
and  colder  part  of  Brazil,  my  remarks  will  be  principally,  though  not  ex- 
clusively, applicable  to  the  diseases  of  that  region. 

The  heat  of  the  climate  prepares  us  to  expect  a  great  prevalence  of  cu- 
taneous diseases,  but  these  are  principally  to  be  found  amongst  the  lower 
classes  and  slaves — the  higher  orders  suffering  scarcely  more  than  the 
inhabitants  of  the  United  States;  an  exemption  probably  attributable  to 
their  great  attention  to  personal  cleanliness,  by  frequent  use  of  general 
and  topical  baths. 

Lepra  is  occasionally  found,  and  elephantiasis,  particularly  of  the  scrotum, 
is  one  of  the  most  common  diseases  in  the  warmer  parts  of  the  country. 


1842.]  Pleasants  on  Prevalent  Diseases  of  Brazil,  ^c.  93 

The  scrotum  is  at  times  so  enlarged  by  it,  as  almost  to  preclude  the  loco- 
motion of  the  unfortunate  individual  afflicted. 

Measles,  scarlet  fever,  and  smallpox,  are  of  very  frequent  occurrence; 
and  I  frequently  was  told  of  epidemics  of  the  most  malignant  and  fatal 
character  of  scarlet  fever,  but  no  opportunity  was  afforded  me  of  seeing 
either  this  disease  or  measles.  A  violent  and  very  fatal  epidemic  of 
variola  occurring  during  my  residence  in  Rio  Grande,  brought  many  cases 
of  this  disease  under  my  notice.  They  presented  no  peculiarities  distin- 
guishing them  from  the  disease  as  it  occurs  in  this  country  in  the  unpro- 
tected— but  the  rapid  extension,  and  frightful  ravages  made  in  that  com- 
munity not  guarded  by  vaccination,  afforded  the  most  satisfactory  evidence 
of  the  salutary  effects  of  that  prophylactic.  Cases  presenting  the  pecu- 
liarities of  varioloid,  as  known  amongst  us,  I  never  saw  during  that  epi- 
demic. 

The  Brazilians  have  never  been  made  fully  aware  of  the  advantages  of 
vaccination.  In  1811  two  vaccine  institutions  were  established  at  Rio  de 
Janeiro,  but  the  operations  there  performed  having  failed  to  protect  from 
smallpox,  a  doubt  of  its  possessing  such  power  gradually  increased;  and 
though  frequent  attempts  at  introducing  this  virus  have  since  been  made, 
but  little  confidence  is  felt  in  the  protection  thus  obtained.  Inoculation 
with  the  virus  of  variola  is  practised  to  a  considerable  extent,  and  so  far 
as  my  experience  (by  no  means  inconsiderable)  may  be  relied  on,  the 
danger  of  the  disease  thus  produced  is  but  small,  when  modified  by  diet 
during  the  period  of  incubation,  though  it  fails  no  less  than  the  natural 
smallpox  to  prevent  the  system  from  a  second  attack. 

The  dangerous  contagion  thus  produced  leads  us,  however,  to  hope  that 
the  blessings  of  vaccination  will  yet  be  duly  appreciated  in  Brazil. 

During  this  epidemic,  fresh  vaccine  virus  was  imported,  with  which  I 
made  several  trials.  The  patients,  all  children,  presented  the  peculiar 
diagnostic  characteristics  of  the  cowpox  sore,  and  being  afterwards  sub- 
jected to  the  contagion  of  smallpox,  all  without  exception  escaped. 

Diseases  of  the  thoracic  viscera  are  less  frequent  by  far  than  in  the 
United  States,  but  are  to  be  found  possessing  the  character  of  all  the 
varieties  here  occurring. 

Though  the  Brazilians  cannot  justly  be  considered  an  intemperate 
nation,  the  higher  classes  indulge  too  freely  in  stimulating  drinks  and  the 
pleasures  of  the  table;  we  therefore  find,  as  might  be  anticipated,  diseases 
of  the  digestive  organs  by  no  means  rare.  Dyspepsia  in  all  its  grades  is 
frequently  encountered,  and  functional  and  organic  diseases  of  the  liver, 
with  their  consequences,  are  of  the  most  frequent  occurrence.  Apoplectic 
and  paralytic  affections  are  also  common. 

Sporadic  cases  of  diarrhoea  and  dysentery  are  observed  at  all  seasons; 
and  during  the  summer,  epidemics  of  them  attacking  all  classes  and  ages 
are  frequent.  It  is  somewhat  remarkable,  however,  that  cholera  morbus 
so  nearly  allied  to  the  above,  is  comparatively  a  rare  disease,  and  in  a  vio- 
lent form  possessing  the  characters  of  Asiatic  cholera,  almost  unknown. 
That  scourge  of  infants  in  the  United  States,  cholera  infantum,  I  never 
saw  during  my  residence  in  the  country. 

Typhoid  and  simple  inflammatory  fevers  present  no  peculiarities,  either 
in  the  frequency  of  their  occurrence  or  symptoms,  distinguishing  them  from 
the  same  diseases  occurring  in  the  United  States;  but  those  febrile  affec- 
tions of  intermitting  and  remitting  types,  arising  from  marsh  miasmata,  it 


94  Medical  Education  and  Institutions,  [July 

is  said,  are  never  to  be  found  in  Brazil.  An  American  physician,  practising 
in  an  adjoining  province,  remarked,  after  several  years  experience,  that  he 
had  never  seen  a  case  of  ague  in  the  country,  excepting  in  foreigners  who 
had  arrived  from  miasmatic  districts  in  the  United  States. 

Tetanus,  comparatively  seldom  seen  in  this  climate,  is  in  Brazil  a  very 
common  disease.  After  changes  in  the  atmosphere  from  hot  and  dry  to 
cold  and  wet,  it  is  not  unusual  for  a  practitioner  to  be  called,  within  a  few 
days,  to  several  cases  of  idiopathic  tetanus;  and  during  such  periods  all 
kinds  of  wounds  are  likely  to  be  followed  by  the  disease;  even  the  simple 
operation  of  phlebotomy  is  at  limes  performed  with  fear,  on  account  of 
such  result  occasionally  following.  The  tendency  to  this  disease  is  found 
to  extend  even  to  the  inferior  animals;  castration  frequently  produces  it, 
and  the  simple  excision  of  part  of  the  tails  of  sheep,  frequently  performed 
to  prevent  a  noxious  disease  to  which  they  are  subject,  is  at  times  followed 
by  the  most  disastrous  consequences,  by  producing  tetanus. 

As  we  might  naturally  be  led  to  anticipate,  from  the  known  immoral 
character  of  the  inhabitants,  diseases  of  the  urinary  and  genital  organs  are 
of  great  frequency.  Calculus,  strictures,  enlarged  prostate,  and  their 
consequences  are  common:  and  the  treatment  of  syphilis  and  gonorrhoea, 
in  all  their  forms  and  varieties,  composes  no  small  item  in  the  ordinary 
labours  of  the  surgical  practitioner.  These  diseases  occurring  in  the 
natives,  present  no  special  marks  of  interest.  But  syphilis  contracted  by 
a  foreigner,  it  has  been  remarked,  and  I  believe  with  truth,  is  peculiarly 
severe,  attacking  the  different  organs  of  the  body,  and  ru-nning  its  course 
with  extreme  rapidity,  and  frequently  proving  fatal. 

Attributable  to  whatsoever  cause,  the  extreme  frequency  of  loxarthrus  is 
particularly  striking.  The  most  frequent  varieties  are  to  be  found  occur- 
ring in  the  knee-joints  of  negroes,  which  are  at  times  so  deformed,  that  the 
leg,  when  extended,  forms  with  a  line  continuing  the  direction  of  the  thigh, 
an  angle  of  60  to  70  degrees,  being  occasionally  directed  outwards  or  in- 
wards, confined  to  one  or  equally  affecting  both  lower  limbs.  Club-foot  is 
10  be  found  in  all  its  varieties,  occurring  about  as  frequently  as  amongst 
our  own  inhabitants. 

Hernia  is  very  frequently  to  be  found,  more  so  than  in  this  country,  and 
at  times  is  to  be  seen  of  an  immense  size;  but  strangulation  of  the  pro- 
truded part  is  much  more  rare  than  amongst  us,  and  when  occurring  de- 
mands less  frequently  an  operation  for  its  relief. 

The  practice  of  midwifery  is  so  generally  confined  to  uneducated  w^o- 
men,  that  a  physician  may  pass  years  in  extensive  practice  without  being 
called  to  a  single  case  of  labour  amongst  the  native  females:  indeed,  his 
aid  is  never  sought,  save  in  unnatural  cases,  and  from  what  I  could  learn 
through  others,  the  fact  appeared  undeniable,  that  native  Brazilians  suf- 
fered much  less  during  the  act  of  parturition  than  the  females  in  this 
country;  however,  the  great  frequency  of  uterine  complaints  occurring 
amongst  married  women,  leads  to  the  opinion,  that  much  advantage  would 
result  from  greater  dependence  upon  scientific  practitioners  in  this  depart- 
ment of  the  profession. 


1842.]  95 


REVIEWS. 


Art.  X. — Traite  des  Nevralgies,  ou  affections  doidoureiises  des  nerfs. 

Par  F.  L.  I.  Valleix,  Medecin  du  Bureau  Central  des  Hopitaux,  &c. 

Paris,  1841,  1  vol.  8vo.  pp.  719. 
^   Treatise  on  Neuralgia.     By  F.  L.  I.  Valleix,  Physician  to  the 

^^Bureau  CentraV  of  the  Hospitals,  &c.     Paris,  1841,  pp.  719,  8vo. 

This  work  is  dedicated  by  its  author  to  M.  Louis,  and  is  one  of  the 
most  recent  monuments  erected  by  the  school  of  which  that  distinguished 
physician  was  the  founder.  By  the  system  of  study  pursued  by  the  mem- 
bers of  that  school,  M.  Valleix  has  done  for  neuralgia  what  M.  Louis  did 
for  typhoid  fever  and  phthisis,  and  other  authors,  in  a  like  way,  for  other 
diseases.  He  has  taught  us  what  neuralgia  is,  as  distinguished  from  affec- 
tions which  previous  authors  have  confounded  with  it;  he  has  discovered  a 
physical  test  by  which  its  existence  and  extent  can  be  certainly  ascertained, 
and  the  best  treatment  correctly  applied;  and  finally,  he  has,  by  the  aid 
of  numbers,  reached  general  conclusions  in  regard  to  it,  which  are  not 
likely  to  be  set  aside,  so  long  as  the  phenomena  of  disease,  as  well  as  of 
health,  shall  be  governed  by  uniform  and  fixed  laws. 

M.  Valleix,  while  he  regrets  the  meagerness  of  the  descriptions  given 
by  most  of  his  predecessors,  has  studiously  examined  all  the  contribu- 
tions to  the  history  of  neuralgia,  contained  in  ancient,  modern,  and 
contemporary  literature;  and  wherever  he  has  found  a  general  portrai- 
ture of  the  disease,  or  particular  cases  of  it,  given  in  any  detail,  he  has 
added  them  to  the  materials  collected  by  himself  for  his  treatise.  With 
such  means  at  his  disposal,  he  has  considered  each  variety  of  neuralgia 
by  itself,  including  the  anatomy  of  the  affected  nerves,  the  literary  history 
of  the  disease,  its  varities,  the  mode  of  detecting  it,  its  symptoms,  both 
general  and  local,  its  course,  duration,  and  termination;  its  lesions;  its 
predisposing  and  exciting  causes;  its  diagnosis  and  prognosis;  its  remedial 
and  prophylactic  treatment.  The  work  concludes  with  an  essay  on  neu- 
ralgia in  general,  in  which  the  characters  common  to  the  several  varieties 
are  brought  together,  forming  a  complete  and  accurate  summary  of  all  that 
is  known  about  the  disease. 

In  giving  an  account  of  the  work,  we  shall  begin  with  this  last  divi- 
sion of  it,  in  order  to  avoid  the  necessity  of  following  the  author  in  his 
very  minute  descriptions,  repeated  as  they  are  for  each  variety  in  succes- 
sion, and  also  to  give  the  reader  a  general  idea  of  the  manner  in  which  the 
subject  is  examined. 

M.  Valleix  gives  the  following  definition  of  neuralgia  as  that  to  which 
his  observations  have  led  him.  "  A  pain  of  variable  intensity  disseminated 
in  certain  circumscribed  points  along  the  course  of  a  nerve;  these  points 
being  proper  centres,  whence  emanate,  at  variable  intervals,  lancinating  or 
other  analogous  pains,  and  upon  which  pressure  is  more  or  less  painful 


96  Reviews.  \_^^^Y 

when  it  is  appropriately  employed."  (P.  2.)  All  those  pains  of  the  internal 
organs  which  have  been  described  and  treated  as  nervous,  are  of  course 
excluded  from  this  definition,  and  intentionally;  for,  while  some  of  them 
are  clearly  dependent  upon  previous  functional  disorder  in  the  organ  where 
they  exist,  and  occupy  a  large  surface  of  that  organ,  others  are  due  to  the 
presence  of  organic  disease,  cancer,  for  instance,  which  presses  upon,  or 
otherwise  excites  pain  in  a  healthy  nerve;  while,  in  neuralgia  proper,  the 
pain  in  the  nerve  is  the  starting  point  of  the  disease,  and  its  characteristic 
symptom;  the  altered  functions  of  the  organ  it  supplies  with  filaments  are 
only  accessory  phenomena.  There  may  be  affinities  between  the  subcu- 
taneous neuralgiae  and  the  painful  affections  of  internal  organs;  but  in  a 
practical  work  the  author  has  done  well  to  disregard  these  doubtful  analo- 
gies, and  confine  his  researches  to  "  an  affection  of  the  principal  nervous 
trunks  which  ramify  near  the  surface  of  the  body,  and  whose  symptoms 
are  so  distinct  as  to  warrant  their  arrangement  in  a  separate  pathological 
group." 

Only  two  of  the  varieties  of  neuralgia  seem  to  have  been  known  to  the 
ancients,  the  sciatic,  and  the  trifacial.  The  former  of  these  was  described 
by  Hippocrates,  and  the  latter  was  noticed  by  Aretojus;  but  for  a  metho- 
dical history  of  the  first  of  these  affections  we  are  indebted  to  Cotunnius 
(1764),  and  of  the  other  to  Andre  (1756).  Chaussier,  in  1804,  originated 
the  term  neuralgia,  and  guided  by  his  anatomical  knowledge,  formed  as 
many  varieties  of  the  disease  as  there  were  single  nerves,  or  nervous 
plexuses,  affected  by  it.  This  classification  gave  clearness  to  the  subject, 
and  was  the  origin  of  many  treatises,  some  of  which  have  notably  favoured 
the  advancement  of  medical  science. 

The  principal  writers  upon  neuralgia  agree  that  the  superficial  nerves 
are  chiefly,  if  not  exclusively,  the  seat  of  the  disease,  but  they  fail  to 
notice  what  particular  points  in  these  nerves  are  most  painful.  M.  Val- 
leix  has  shown  that  the  severest,  and  often  the  only  pain  in  a  nerve 
exists  where  this  latter  becomes  superficial  lohether  by  emergirigfrom  a 
bony  or  muscular  enclosure,  or  by  the  distribution  of  its  terminating 
branches  to  the  integuments.  Illustrations  of  this  proposition  will  be  given 
when  we  come  to  speak  of  the  several  forms  of  neuralgia. 

The  prominent  symptom  of  neuralgia  is  pain;  every  other  is  only  secon- 
dary to  this;  hence  in  a  general  description  of  the  disease,  we  have  to 
attend  to  the  seat,  and  the  character,  including  the  degree,  and  the  varia- 
tions, of  the  pain.  First,  then,  as  regards  its  seat.  When  a  patient  suffering 
under  an  attack  of  neuralgia  is  asked  where  he  feels  the  pain,  he  will 
either  complain  of  it  in  the  whole,  or  in  certain  points  of  the  course  of 
a  nerve,  generally  using  the  former  description  during  the  paroxysms  of 
lancinating  pain,  and  the  latter  in  the  intervals  between  them.  It  is  dur- 
ing the  paroxysms,  that  the  pain  is  felt  over  the  most  extensive  surface, 
not  only  in  the  trunk,  but  in  one  or  more  of  the  superficial  branches  of  the 
nerve  primitively  affected,  and  in  those  of  the  neighbouring  nerve  with 
which  they  anastomose;  in  this  way  the  disease  may  be  propagated  by 
contiguity,  and  by  the  more  intimate  connections  of  nervous  filaments,  until 
it  invades  almost  the  whole  body.  Some  nerves,  however,  seem  to 
have  the  disease  strictly  confined  to  themselves,  during  its  whole  course; 
such  are  the  inferior  maxillary,  ulnar,  and  ilio-scrotal  nerves,  perhaps  be- 
cause their  branches  anastomose  but  sparingly  with  otiier  nerves  derived 
from   the  same  sources.     The  usual  restriction  of  the  disease  to  a  sing-le 


1842.]  Valleix  on  Neuralgia,  97 

nerve,  or  set  of  nerves,  has  given  rise  to  its  division  into  trifacial,  bra- 
chial, and  other  varieties,  to  be  presently  considered  in  detail. 

The  character  of  the  pain  is  twofold:  it  may  be  either  dull,  and  con- 
stant, like  that  of  a  bruise,  or  may  be  sharp,  lancinating,  intermittent,  or 
irregular;  and  either  of  these  pains  may  be  spontaneous,  or  excited  either 
by  the  movements  of  the  patient,  or  by  external  pressure.  The  dull  pain, 
although  not  the  most  violent,  is  very  annoying,  (a  fact  observed  by  Co- 
tunnius,  but  neglected  by  many  subsequent  writers,)  and  is  absent  in 
very  few  cases. 

The  lancinating  pains  have  been  found  by  M.  Valleix  to  emanate  uni- 
formly from  one  or  more  of  the  points  occupied  by  the  pain  just  described, 
or  by  that  which  pressure  occasions.  These  are  centres  whence  the  pain 
radiates  with  greater  or  less  acuteness,  and  which  are  always  painful  them- 
selves, while  the  nervous  trunks  between  them  are  only  momentarily 
affected.  Sometimes,  indeed,  a  pain  will  pass  from  one  to  another  of 
these  centres,  without  causing  any  sensation  in  the  intermediate  nerve,  and 
this  latter  may  remain  quiescent  between  points  which  are  at  the  same 
instant  the  seat  of  intense  suffering.  The  darting  pain  may  also  fol- 
low a  direction  opposite  to  that  of  the  nerve.  This  peculiarity  was 
observed  in  6  out  of  109  cases,  while  in  62  of  them  the  pain  was  in  the 
course  of  the  nerve;  in  16  it  was  fixed  and  disseminated;  in  11  felt  some- 
times in  one  point,  and  sometimes  in  another;  in  5  it  started  from  the  same 
spot  to  shoot  upwards  and  downwards;  in  6  followed  no  regular  direction; 
and  was  absent  in  3  cases. 

M.  Valleix  found  that  when  a  nerve  is  affected  with  neuralgia,  a  greater 
or  less  number  of  its  superficial  points  are  morbidly  sensible  to  pres- 
sure. But  the  majority  of  medical  writers,  so  far  from  admitting  that 
pressure  upon  a  neuralgic  nerve  gives  rise  to  pain  in  it,  insist  that  it  has  a 
soothing  influence  in  most  cases.  Some  indeed  say  that  slight  pressure 
augments,  while  firm  dissipates  the  pain;  others  think  that  pressure  is  not 
painful  at  all,  and  others,  again,  admit  it  to  be  so,  but  very  rarely.  But 
M.  Valleix  shows  that  the  existence  of  this  symptom  was  recorded  in 
thirty-nine  out  of  a  hundred  and  thirty-four  cases  observed  by  the  very 
authors  who  have  asserted  its  absence,  and  in  most  of  the  ninety-five  other 
cases,  there  is  nothing  to  prove  that  the  symptom  was  made  a  subject 
of  inquiry  at  all.  This  is  not  a  solitary  example  of  men  putting  forth 
general  propositions  which  the  particular  facts  collected  by  themselves 
flatly  contradict.  It  is  much  easier  to  write  one's  general  recollections, 
than  to  make  a  strict  analysis  of  what  has  been  really  observed. 

M.  Valleix  examined  every  case  of  neuralgia  that  came  under  his  notice, 
with  a  view  to  determine  this  question,  and,  with  a  single  exception,  he 
found  the  affected  nerve  painful  upon  pressure,  in  one  or  more  points;  the 
exception  was  a  slight  case  of  sciatica  observed  by  him  only  within  thirty- 
six  hours  of  its  onset;  the  symptom  was  then  absent,  but  may  have  existed 
subsequently.  The  pain  upon  pressure  sometimes  consists  merely  in  a 
temporary  aggravation  of  the  constant  dull  pain,  and  sometimes  in  shoot- 
ing ones  like  those  which  occur  spontaneously.  The  slightest  weight 
upon  a  tender  point  is  sometimes  enough  to  bring  on  frightful  paroxysms^ 
or  cause  the  patient  to  shriek  with  anguish. 

The  extent  of  the  painful  surface  is  readily  ascertained  by  pressure,  and 
has  frequently  been  found  not  to  exceed  a  quarter  of  an  inch  in  diameter, 
its  limits  being  so  abruptly  defined,  that  at  the  distance  of  a  single  line 
No.  VII.— July,  1842.  9 


98  Reviews,  [July 

from  a  point  where  pressure  produced  pain,  no  evidence  of  morbid  sensi- 
bility could  be  elicited.  It  cannot  be  doubted  that  here  is  one  of  the  rea- 
sons why  the  descriptions  of  previous  authors  have  been  imperfect.  It  is 
easy  to  conceive  that  painful  points  of  so  small  extent  might  escape  the 
notice  of  a  superficial  observer,  and  that  pressure  with  the  open  hand  might 
fail  to  produce  any  effect  upon  them,  because  bearing  principally  upon  the 
surrounding  indolent  parts.  When  writers  have  affirmed  the  existence  of 
spots  painful  under  pressure,  they  must  have  fallen  by  chance  upon  a  ten- 
der point,  or  have  met  with  those  exceptional  cases  where  the  sensitive 
surface  is  unusually  large.  In  order,  then,  to  determine  the  state  of  a 
neuralgic  nerve,  the  whole  of  its  trunk  and  principal  ramifications  must  be 
carefully  pressed  with  the  end  of  the  finger,  both  in  the  parts  complained 
of  by  the  patient,  and  in  those  where  there  is  no  spontaneous  pain.  For 
pressure  may,  in  the  latter  case,  excite  pain,  and  indicate  the  extent  of  the 
affection. 

It  should,  however,  be  borne  in  mind  that,  occasionally,  when  pain  has 
been  caused  by  pressure  on  a  given  point,  a  few  moments  afterwards 
the  same  experiment  may  not  have  a  similar  result,  although  a  short  pe- 
riod of  repose  will  again  restore  to  the  point  its  original  sensibility.  There 
are,  too,  some  parts  of  the  body,  such  as  the  anterior  wall  of  the  chest,  and 
the  scrobiculus  cordis,  which  are  naturally  painful  under  moderately  firm 
pressure  in  thin  persons  of  a  nervous  temperament.  If  pain,  therefore,  is 
found  in  such  points,  it  should  not  be  attributed  to  neuralgia,  without 
making  pressure  upon  a  corresponding  part  of  the  opposite  side  of  the 
body.  If  it  is  absent  there,  the  pain  first  observed  may  be  referred  to  a 
simple  neuralgia.  In  cases  of  double  neuralgia,  one  side  is  usually  more 
painful  than  the  other;  there  is,  moreover,  between  the  opposite  tender 
points,  a  considerable  indolent  space,  while  a  continuous  soreness  is  found 
there  in  cases  of  general  morbid  sensibihty,  presented  by  the  individuals 
just  referred  to. 

The  pain  excited  by  pressure  is  generally  in  direct  proportion  to  the 
violence  of  the  disease,  is  greatest  during  the  paroxysms,  and  least  in  the 
intervals  between  them;  it  is  almost  uniformly  to  be  found  in  the  points 
where  pain  exists  spontaneously.  Thus,  in  111  out  of  112  cases,  the 
excited  and  spontaneous  pains  coincided  in  the  same  points;  the  latter  ex- 
isted without  the  former  in  one  case  only.  But  this  coincidence  did  not 
happen  strictly  in  every  affected  point  of  each  patient;  in  some  parts,  one  sort 
of  pain  only  was  manifest,  but  in  other  parts  of  the  same  individual,  the  two 
were  always  found  conjoined.  It  will  be  perceived  how  important  is  this 
physical  exploration  to  the  discovery  of  the  seat  of  the  disease;  its  value 
will  appear  still  greater  when  we  come  to  the  subject  of  treatment. 

We  pass  over  the  paragraphs  relating  to  the  functional  changes  in 
organs  supplied  by  nerves  affected  with  neuralgia,  and  to  secondary 
symptoms  and  complications,  merely  noticing  the  author's  statement,  that 
in  females  suffering  under  this  disease  the  menstrual  function  is  very  fre- 
quently disordered.  Thus  in  24  out  of  65  patients,  it  was  regular  and 
without  pain;  in  the  others  there  was  irregular,  painful,  or  deficient 
menstruation.  Before  drawing  any  conclusion  from  these  premises,  we 
should  have  to  ascertain  what  proportion  of  otherwise  healthy  women,  in 
a  large  city  like  Paris,  enjoy  an  exemption  from  all  the  disorders  to  which 
the  catamenia  are  liable.  We  suspect  that  the  number  would  be  found 
much  smaller  than  is  commonly  supposed. 


1842.]  Valleix  on  Neuralgia,  99 

Neuralgia  is  eminently  a  paroxysmal  disease.  Out  of  155  cases,  one 
only  was  without  this  character.  But  there  is  a  striking  difference  be- 
tween paroxysms  occurring  at  irregular  intervals,  and  those  whose  periodi- 
city at  once  suggests  the  idea  of  a  latent  intermittent  fever.  The  instances 
of  the  latter  sort  are  infrequent;  they  were  noted  in  about  one-tenth  of  the 
cases  of  neuralgia  of  all  kinds.  But  regular  intermissions  were  most  com- 
mon in  the  trifacial  variety,  that  is,  in  nearly  one-fourth  of  the  cases,  while 
they  were  observed  only  in  about  one-seventeenth  of  the  cases  of  the  other 
varieties.  It  is  worthy  of  remark,  that  although  sulphate  of  quinine  was 
administered  in  all  the  cases  where  periodicity  seemed  to  indicate  its  use, 
yet  about  half  of  them  only  appeared  to  yield  to  the  remedy,  and  the  rest 
were  quite  unaffected  by  it. 

It  has  often  been  said  that  the  onset  of  neuralgia  is  sudden.  This  is 
true  of  the  individual  paroxyms  for  the  most  part,  but  not  of  the  disease 
itself.  Its  accession  is  more  commonly  gradual,  not  only  as  to  the  inten- 
sity of  the  pain,  but  also  as  regards  the  number  of  the  points  attacked. 
These  are  few  at  first,  but  go  on  increasing  in  number.  When  the  disease 
is  at  its  height,  it  is  subject  to  frequent  variations,  which  many  physicians 
have  attributed  to  atmospheric  changes.  M.  Valleix,  however,  has  found 
only  a  low  temperature,  and  that  independent  of  moisture  or  dryness,  evi- 
dently coinciding  with  the  severest  attacks  or  paroxysms  of  neuralgia. 

The  duration  of  neuralgia  is  uncertain.  Its  termination  is  never  fatal; 
a  radical  cure  was  effected  in  about  three-fourths  of  the  cases  observed 
and  collected  by  M.  Valleix;  (139  out  of  182.)  Many  of  these  cases  were 
probably  taken  from  the  works  of  physicians  who  had  published  them  as 
proofs  of  the  success  of  some  favourite  treatment,  and  the  result  to  which 
they  lead  ought  to  be  received  with  caution,  especially  when  we  consider 
that  the  cure  obtained  is  rather  of  the  particular  attack,  than  of  the  disease 
itself,  since  in  persons  once  subject  to  it,  there  is  a  strong  predisposition 
to  its  recurrence  upon  the  slightest  inattention  to  prophylactic  measures. 

Like  most  other  diseases,  neuralgia  is  much  more  curable  in  its  earlier 
stages  than  subsequently.  Yet  a  cure  must  not  be  despaired  of,  even 
when  the  disease  appears  inveterate,  for  it  has  been  effected,  says  M.  Val- 
leix, in  cases  of  six,  thirteen,  and  fourteen  years  standing. 

As  to  the  anatomical  lesions  of  neuralgia,  all  our  knowledge  concerning 
them  must  be  expressed  in  a  single  sentence.  The  changes  found  in 
nerves  which  had  been  the  seat  of  this  disease  are  far  from  beins^  peculiar 
to  it;  and,  on  the  other  hand,  it  is  certain  that  neuralgia  may  exist  during 
a  long  term  of  years,  without  leaving  behind  it  any  appreciable  lesion. 

The  causes  of  neuralgia  are  involved  in  great  obscurity.  In  a  large 
majority  of  cases,  no  cause  can  be  assigned  for  an  attack  of  the  disease, 
but  in  a  certam  number  of  his  cases,  M.  Valleix  thinks  that  the  prolonged 
action  of  severe  cold  was  the  immediate  source  of  the  malady.  In  regard 
to  the  predisposmg  causes,  M.  V.  has  shown  that  of  297  cases,  more  than 
two-thirds  of  them  occurred  in  persons  between  twenty  and  fifty  years 
old;  a  proposition  equally  applicable  to  a  great  variety  of  diseases.  It 
follows  also,  from  the  analysis  of  our  author,  that  the  two  sexes  are  equally 
liable  to  the  disease,  but  that  of  its  varieties,  the  sciatic  and  crural  neural- 
gias are  most  common  in  males,  and  the  dorso-intercostal  and  lumbar, 
in  females.  These  results  are,  however,  only  given  as  provisional;  a 
much  larger  number  of  cases  than  have  yet  been  collected  are  necessary 
for  the  true  solution  of  the  problem  relative  to  this  point,  as  well  as  to  the 


100  Reviews.  [July 

constitution,  temperament,  and  condition  of  the  patient,  his  mode  of  life, 
food,  &LC.  The  influence  of  the  seasons  is  hardly  doubtful:  of  125  cases, 
77  commenced  during  the  five  months  beginning  with  December,  and  48 
during  the  other  seven  months,  so  that  the  proportion  during  the  cold 
weather  was  about  double  of  that  furnished  by  the  warm  seasons. 

Diagnosis. — Neuralgia  is  very  liable  to  be  confounded  with  neuritis. 
The  distinctive  characters  of  the  two  have  been  laid  down  by  M.  Martinet 
and  other  authors.  According  to  them  the  pain  of  neuritis  is  more  fixed, 
and  may  be  recognized  by  the  shortness  and  imperfection  of  its  remissions, 
by  its  gradual  rather  than  its  sudden  return,  and  by  its  aggravation  under 
pressure.  M.  Valleix  is  not  convinced  that  these  symptoms,  and  espe- 
cially the  last  one,  are  characteristic  of  neuritis,  but  does  not  take  upon 
himself  to  decide  the  question  without  further  observation.  When  a 
nerve  is  pricked,  torn,  or  bruised,  or  compressed  by  a  tumour,  it  may  be 
the  seat  of  lancinating  pains  like  those  of  true  neuralgia.  Is  there  any- 
thing besides  the  evidence  furnished  by  the  history  of  such  a  case  to  dis- 
tinguish it  from  neuralgia?  This  too  is  a  subject  which  requires  the 
examination  of  observant  physicians.  Muscular  rheumatism  is  a  very 
analogous  disease  to  the  one  under  discussion.  It  consists  merely,  in  pain, 
which  has  a  superficial  seat,  and  is  often  marked  by  exacerbations,  but  it 
may  be  known  by  its  occupying  a  more  extensive  surface  than  neuralgia 
does;  by  its  increase  during  contraction  of  the  aflected  muscles,  for  the 
pain  so  excited  is  always  much  more  intense  than  the  spontaneous  one; 
and  lastly,  by  its  vagueness  in  rheumatism,  while  it  accurately  follows  the 
course  of  the  nerve  in  neuralgia. 

The  article  on  general  treatment  will  find  a  more  appropriate  place  after 
our  analysis  of  the  chapters  which  describe  minutely  the  several  varieties 
of  neuralgia;  and  to  them  we  now  proceed. 

Trifacial  Neuralgia. — We  omit  the  excellent  description  given  by  the 
author  of  the  distribution  of  the  fifth  pair  of  nerves,  and  pass  at  once  to 
his  general  remarks  upon  the  disease.  Fifty-five  cases  form  the  basis  of 
his  essay,  and  of  these  only  twelve  were  observed  by  himself  in  all  their 
details.  The  rest,  which  are  borrowed  from  various  native  and  foreign 
authors,  are  silent  in  regard  to  many  important  points. 

M.  Valleix  thinks  that  trifacial  neuralgia  ranks  next  in  frequency  after 
the  dorso-intercostal  and  lumbar  varieties.  As  regards  its  causes,  the  re- 
marks already  made  upon  neuralgia  in  general  will  apply  to  this  form  of  it. 
It  frequently  happens,  however,  in  persons  of  a  nervous  temperament,  and 
in  those  who  have  suffered  from  diseases  of  the  nervous  system.  There 
is  no  evidence  of  its  ever  following  upon  syphilis.  Caries  of  the  teeth  has 
given  rise  to  it,  although  no  instance  of  this  has  occurred  to  M.  Valleix.  It 
is  equally  liable  to  attack  either  side  of  the  face,  but  is  rarely  double. 
When  a  single  branch  of  the  nerve  is  aflfected,  it  is  usually  the  inferior 
dental.  The  two  varieties  of  pain  above  described  are  met  with,  the  dull 
and  the  lancinating,  and  these  at  the  points  of  emergence,  or  anastomosis 
of  the  nerves,  as  shown  in  the  following  abstract. 

A.  Painful  points  in  the  course  of  the  ophthalmic  branch, — 1st.  At 
the  supra-orbital  foramen. — Eleven  times  out  of  thirteen  the  patients 
ferred  to  this  spot  as  the  seat  of  their  pain,  although  in  two  cases  it  ex- 
tended for  a  certain  distance  along  the  nerve.  2d.  Two  patients  com- 
plained of  a  pain  in  the  eyelid  and  the  edge  of  the  orbit,  which  probably 
resided  in  the  nasal  branch  of  the  ophthalmic.     3d.  Three  had  a  painful 


1842.]  Valleix  on  Neuralgia.  101 

point  just  within  and  below  the  internal  canthus  of  the  eye.  This  point 
is  mentioned  by  various  authors  sixteen  times,  but  is  not  accurately 
defined  by  them.  4th.  Several  patients  complained  of  pain  in  the  eyeball 
itself;  in  one  it  was  confined  to  that  organ;  similar  cases  are  described  by 
authors.  M.  Valleix  was  not  able  in  any  instance  to  discover  pain  in  the 
tiunk  of  the  nerve,  while  in  its  bony  canal,  but  only  when  it  became 
superficial. 

B.  Painful  points  in  the  course  of  the  superior  maxillary  branch. — 1st. 
At  the  infra-orbitary  foramen. — A  dull  pain  existed  there  in  the  three  out 
of  fourteen  patients  seen  by  M,.  Valleix,  and  is  noticed  only  six  times  in  the 
cases  of  various  authors,  from  which  it  is  inferred  that  this  is  not  a  frequent 
seat  of  the  disease.  2d.  Over  ihe  malar  bone.  3d.  The  teeth  and  gums 
of  one  side  were  the  seat  of  a  vague  and  diffused  pain  in  nine  cases  out 
of  sixteen;  in  the  remaining  seven  the  pain  was  confined  either  to  the 
upper  or  to  the  lower  jaw.  4th.  The  upper  lip.  5th.  The  palate  was 
affected  by  neuralgic  pain  in  four  cases  detailed  by  authors,  in  one  of 
which  the  right  side  of  the  tongue,  as  well  as  of  the  palate,  was  so  much 
involved  as  to  prevent  the  articulation   of  words,  during  the  paroxysm. 

C.  Painful  points  in  the  course  of  the  inferior  maxillary  branch. —  1st. 
The  temple. — A  sharp  pain  was  felt  in  six  cases  at  the  lower  part  of  the 
temporal  region,  just  in  front  of  the  ear,  and  in  every  instance  the  surface 
affected  did  not  exceed  two-fifths  of  an  inch  in  diameter.  2d.  The  tern- 
poro-maxillary  articulation  was  painful  in  one  case  where  the  disease  was 
limited  to  the  inferior  maxillary  nerve.  3d.  The  mental  foramen  was  the 
seat  of  pain  in  five  cases  observed  by  the  author,  and  in  two  recorded  by 
other  writers.  It  should  be  remarked  that  where  this  point  existed,  the  tem- 
poral was  also  found,  making  it  probable  that  the  latter  was  in  the  course  of 
the  branch  of  the  fifth  nerve  supplying  the  region  of  the  same  name. 

Parts  of  the  tongue  and  lower  lip  are  also  painful  occasionally. 

D.  Painful  points  where  the  branches  of  the  trigeminus  anastomose. 
— The  most  remarkable  of  these  is  the  parietal,  and  is  usually  found 
a  litde  above  the  protuberance  of  that  bone,  and  occupies  a  space  not 
exceeding  half  an  inch  in  diameter.  M.  Valleix  observed  it  in  one  half  of 
the  cases  analysed  in  his  treatise,  and  has  since  had  occasion  to  recognise 
it  in  five  patients.  It  may  indeed  be  said  that  this  point  is  constant  in  all 
pretty  severe  neuralgias  of  the  face,  excepting,  however,  when  the  disease 
is  limited  to  the  inferior  dental  nerve. 

The  question  now  occurs,  what  divisions  of  trifacial  neuralgia  should  be 
admitted?  The  greater  part  of  authors,  with  Chaussier  at  their  head,  have 
made  as  many  divisions  as  there  are  nervous  filaments  interested.  But  if 
we  regard  the  following  resiilt  it  will  be  evident  that  such  minuteness  must 
be  barren  of  all  practical  utility. 

Painful  points  in  all  three  branches  24  times. 
"  two  "         11     " 

"         "  one  branch  10     " 

From  this  table  it  appears  that  the  cases  in  which  one  branch  of  the 
trigeminus  was  alone  affected,  were  not  numerous,  even  supposing  the 
table  to  be  rigorously  correct.  But,  very  probably,  the  authors  from  whom 
some  of  these  numbers  are  borrowed  noted  the  existence  of  the  disease  in 
one  branch  only  because  the  pain  was  severest  there,  and  certainly  they 
did  not  use  the  test  of  pressure  to  determine  the  state  of  the  other  branches. 

9* 


102  Reviews.  [July 

Hence  we  are  led  to  view  facial  neuralgia  as  the  same  disease,  in  whatever 
branch  of  the  fifth  pair  it  may  be  seated.  In  regard  to  the  point  where 
the  affection  usually  begins,  M.  Valleix  can  find  no  case  of  its  originating 
in  the  superior  maxillary  nerve;  but  of  22  cases  noted  by  himself  and 
others,  sixteen  commenced  in  filaments  of  the  first  branch,  whence  it  ex- 
tended to  others,  and  six  in  the  inferior  dental  nerve,  where  it  remained 
fixed. 

The  "  points"  which  have  been  indicated  must  be  looked  upon  as  centres 
of  pain,  and  characteristic  of  neuralgia.  Pressure  upon  them  nearly  always 
caused  suffering,  and  that  within  very  narrow  limits,  so  that  on  one  side 
of  a  line  there  would  be  acute  pain,  and  on  the  other  none  whatever.  In 
many  instances  pressing  very  lightly  brought  on  severe  pain,  but  in  none 
was  a  contrary  effect  produced  by  firm  pressure,  so  far  from  it  that  the 
anguish  was  then  intolerable.  Pressure  rarely  developed  pain  in  the  in- 
tervals between  the  "  points,"  these  latter  were  always  more  sensitive 
than  the  other  portions  of  the  nerves,  and  in  almost  every  case  the  seat  of 
spontaneous  suffering.  A  large  majority  of  the  patients  experienced  a 
remarkable  exacerbation  of  their  symptoms  during  mastication  and  deglu- 
tition, sometimes  while  blowing  the  nose,  or  moving  the  head  or  eye. 

Spontaneous  lancinating  pains  occurred  at  variable  intervals,  sometimes 
following  the  course  of  the  nerve,  sometimes  going  contrary  to  it,  and 
sometimes  starting  from  distant  points  simultaneously.  Various  sensations 
also  existed  at  the  same  time,  such  as  of  burning,  gnawing,  boring,  or  of 
simple  tension;  some  patients  compared  their  pain  to  an  electric  shock,  a 
dragging,  pinching,  &;c.  Occasionally  the  state  of  the  parts  supplied  by 
the  trigeminus  was  altered.  Thus  in  a  certain  number  of  cases  there  was 
intolerance  of  light,  redness  of  the  eye,  and  an  involuntary  flow  of  tears; 
less  frequently  there  was  heat  in  the  nose,  and  a  mucous  discharge  from 
its  lining  membrane.  Some  patients  complained  of  humming  and  whist- 
ling sounds  in  their  ears,  but  none  had  toothache.  These  symptoms  be- 
longed to  the  more  serious  cases,  and  so  did  contortions,  convulsions, 
spasms,  and  tremulous  movements  of  the  face.  Some  authors  have  at- 
tributed these  phenomena  to  nearly  all  cases  of  the  disease  which  they 
eutide  "  tic  douloureux,"  but  it  is  plain  that  their  descriptions  do  not 
include  the  milder  and  more  numerous  cases.  The  intermissions  be- 
tween the  paroxysms  were  commonly  very  irregular,  and  in  instances  of 
apparently  well  marked  periodicity,  "  the  failure  of  sulphate  of  quinine," 
says  our  author,  "  frequently  proved  that  there  was  really  no  intermittent 
fever;"  a  conclusion  we  should  be  sorry  to  adopt  on  such  evidence.  It  is 
not  more  rational  to  deny  the  existence  of  intermittent  fever  in  cases 
where  the  preparations  of  cinchona  are  unable  to  cure  the  disease,  than  it 
would  be  to  consider  the  syphilitic  nature  of  an  affection  disproved  because 
it  had  not  yielded  to  mercury.  Experience  and  science  have  done  justice 
upon  the  latter  opinion,  once  universal,  and  we  should  therefore  be  the 
more  cautious  how  we  admit  a  similar  belief  in  regard  to  any  medicine 
whose  usual  success  in  curing  a  particular  disease  may  tempt  us  into  call- 
ing it  a  specific. 

The  exacerbations  of  pain  in  trifacial  neuralgia  took  place  equally  by  day 
and  by  night,  and  more  usually  under  the  influence  of^  a  notably  diminish- 
ed temperature,  than  any  other  appreciable  cause.  Its  duration,  alleged 
anatomical  lesions,  and  essential  nature,  require  no  notice  here. 

The  diagnosis  between  it  and  inflammatory  afTections  of  the  head  is 


1842.]  Valleix  on  Neuralgia.  103 

easy,  especially  when  the  aid  of  pressure  upon  the  nerves  is  resorted  to. 
M.  Valleix  thinks  that  nervous  headache  (migraine)  is  often  neuralgic,  and 
claims  hystericus  always  so.  To  this  latter  opinion  we  can  add  the  sup- 
port of  one  case,  where,  during  the  painful  hysteric  paroxysm,  and  for 
some  time  after,  there  was  great  tenderness  on  pressure  over  the  parietal 
protuberance,  the  mastoid  process,  and  the  point  designated  by  M.  V. 
as  "  temporal,"  just  in  front  of  the  ear:  and  of  another  where  pressure 
gave  pain  at  the  lower  part  of  the  temple,  and  at  a  point  about  halfway 
between  the  mastoid  process  and  the  spine.  In  both  these  cases  there 
was  puffiness  of  one  side  of  the  scalp  during  the  paroxysm;  in  both  there 
was  also  more  or  less  delirium;  the  one  patient  had  previously  been  sub- 
ject to  hysterical  convulsions;  the  other  was  anemic,  and  just  conva- 
lescent from  an  attack  of  dorso-intercostal  neuralgia  when  the  disease 
attacked  her  head. 

M.  Valleix  examines  with  great  minuteness,  and  in  a  very  interesting 
manner,  the  question:  "  Is  the  facial  nerve  ever  the  seat  of  neuralgia?" 
We  can  only  give  an  abstract  of  his  principal  conclusions.  "When  his 
patients  were  interrogated  they  uniformly  declared  that  the  pain  darted 
from  behind  the  ear  upon  the  face,  and  had  he  taken  their  word  for  it  with- 
out inquiring  further,  he  might  have  been  led  into  error  like  most 
others.  But,  by  means  of  closer  questions  and  the  use  of  pressure,  it 
turned  out,  1st,  that  it  was  not  either  immediately  from  under  or  behind  the 
ear  that  the  pain  darted,  but  from  behind  the  mastoid  process,  and  at  some 
variable  point  between  it  and  the  vertebral  column;  2(1,  that  the  shooting 
pains  passed  over  the  occipital  bone  at  a  greater  or  less  distance  from  the 
ear,  to  be  felt  above  the  parietal  protuberance;  .3d,  that  at  this  spot  there 
was  a  sensitive  point  whence  pain  could  radiate  over  the  different  parts 
of  the  face  by  means  of  the  branches  of  the  temporal  and  frontal  nerves. 
From  the  whole  discussion  it  is  to  be  inferred, 

1st,  That  there  is  nothing  in  the  anatomical  distribution  of  the  nerves  of 
the  face  to  prove  that  in  a  given  case  the  pain  resides  in  the  facial  rather 
than  in  the  fifth  nerve,  since  their  terminating  branches  anastomose  at  all 
points  where  pain  has  been  said  to  exist  in  the  former. 

2d.  The  most  conclusive  physiological  experiments  have  shown  the 
facial  nerve  to  be  naturally  insensible. 

3d.  The  recorded  cases  of  so-called  neuralgia  of  the  portio  dura  are 
wanting  in  the  most  important  details. 

4th.  In  cases  siri^ilar  to  those  on  record,  the  point  of  departure  of  the 
pain  has  been  found  not  in  the  facial,  but  in  the  occipital  nerves. 

5th.  If  neuralgia  should  hereafter  be  found  to  exist  in  the  facial  nerve, 
the  intimate  anastomosis  it  forms  with  the  trigeminus  will  sufhce  to  ex- 
plain its  acquired  sensibility. 

Cervico-Occipital  Neuralgia. — The  nervous  branches  concerned  in 
this  disease  are,  1st,  The  superficial  cervical,  which  passes  under  the  skin  at 
the  posterior  edge  of  the  sterno-cleido-mastoid  muscle,  about  the  middle 
of  the  neck;  2d,  the  auricular;  3d,  a  branch  of  the  anterior  trunk  of  the 
second  cervical  nerve  which  ascends  behind  the  mastoid  process  towards 
the  parietal  bone;  4th,  the  supra-clavicular,  and  acromial;  and,  most 
important  of  all,  the  occipital,  which  is  a  continuation  of  the  posterior 
trunk  of  the  first  cervical  nerve,  and  accompanies  the  occipital  artery,  after 
traversing  the  trapezius  muscle;  its  branches  supply  the  scalp,  and  many 
of  them  anastomose  with  those  of  the  frontal  nerve  above  the  parietal  pro- 


104  Hevieios»  [July 

taberance.  The  following  are  the  points  where  pressure  excites  pain:  1st, 
one,  and  the  most  sensitive,  between  the  mastoid  apophysis  and  the  first 
cervical  vertebra,  a  little  nearer  the  latter  than  the  former;  2d,  at  the 
emergence  of  the  superficial  cervical  nerve;  3d,  near  the  parietal  protu- 
berance; 4th,  upon  the  mastoid  process;  5th,  upon  the  concha. 

This  form  resembles  trifacial  neuralgia  in  the  character  of  its  pain,  but 
is  of  much  rarer  occurrence.  The  direction  and'  extent  of  the  pain  has 
already  been  noticed  in  connection  with  the  subject  of  facial  neuralgia,  so 
that  we  may  pass  to  the  next  variety. 

Cervico  Brachial  Neuralgia,  may  occupy  one  or  several  of  the 
branches  of  the  last  four  cervical  and  first  dorsal  nerves,  either  before  or 
after  their  intertexture  in  forming  the  axillary  plexus.  The  most  import- 
ant points  are  the  following:  1st,  where  the  posterior  branches  emerge  from 
the  muscles  at  the  sides  of  the  lower  cervical  vertebrae;  2d,  where  the 
plexus  in  the  axilla  is  superficial;  3d,  where  the  supra-scapular  and  cir- 
cumflex  branches  are  found,  the  former  upon  the  spine  of  the  scapula,  the 
other  around  the  surgical  neck  of  the  humerus,  and  between  the  integu- 
ments and  the  deltoid;  4th,  where  the  internal  cutaneous  nerve,  superfi- 
cial along  the  inner  side  of  the  arm,  is  distributed  partly  to  the  internal 
condyle,  and  partly  to  the  anterior  face  of  the  wrist,  after  furnishing  a  fila- 
ment placed  behind  the  median  basilic  vein,  and  which,  when  wounded  in 
venesection,  has  been- the  seat  of  intense  suffering;  5th,  where  the  median 
nerve  passes  through  the  pronator  teres,  and  where  it  gives  off  the  palmar 
cutaneous  branch  and  supplies  the  sides  of  the  fingers;  6th,  where  the 
ulnar  nerve  lies  behind  the  internal  condyle,  where  it  passes  superfi- 
cially between  the  pisiform  and  unciform  bones  to  reach  the  hand,  where 
it  sends  off  filaments  to  the  last  three  fingers;  7th,  where  the  musculo- 
spiral  passes  round  the  humerus,  and  gives  off  cutaneous  branches  at  its 
entrance  into,  and  its  exit  from,  the  humeral  groove. 

Any  of  these  points  may  be  the  seat  of  spontaneous  pain,  or  of  that  pro- 
duced by  pressure,  but  both  sorts  are  most  frequently  found  in  the  axilla, 
in  front  of  the  elbow  and  the  wrist,  and  behind  the  internal  condyle.  The 
last  situation  is  the  most  common  of  all  the  painful  localities,  and  the  affec- 
tion of  the  ulnar  nerve  by  far  the  most  frequent. 

Dorso-intercostal  Neuralgia. — The  study  of  this  variety  was  ne- 
glected until  1818,  when  the  memoir  of  Nicod  was  published.  This  author 
mentions  his  having  met  with  two  hundred  cases  of  the  disease,  and  gives 
a  general  description  of  it,  in  which  he  asserts  that  it  occurs  much  oftener 
upon  the  left,  than  upon  the  right  side,  in  the  proportion,  namely,  of  15:1. 
M.  Valleix  passes  rapidly  in  review  the  essays  of  French,  English,  and 
American  writers  who  seem  to  have  had  this  subject  in  view,  and  amongst 
the  latter  the  papers  of  Dr.  J.  Parrish  and  Dr.  Porter  published  in  this 
Journal.  The  want  of  precision  in  describing  symptoms,  and  the  per- 
petual mingling  with  them  of  hypothetical  notions  make  these  works  of 
small  value.  The  vague,  or  rather  meaningless  term,  "  spinal  irritation," 
and  the  quackery  of  one  or  two  books  concerning  it,  which  nevertheless 
emanated  from  sources  of  some  consideration,  were  both  adapted  to  turn 
scientific  inquirers  aside  from  a  subject  which  had  been  wrested  from  its 
native  domain  by  the  unhallowed  hands  of  nostrum-mongers.  The  first 
researches  into  the  symptoms  of  this  disease,  which  are  entitled  to  be 
called  scientific,  are  those  of  M.  Bassereau  in  his  inaugural  thesis,  and  those 
of  M.  Valleix,  both  published  about  the  beginning  of  1840,  in  the  "  ./^r- 


1842.]  YaWe'ix  on  Neuralgia.  105 

chives  Generates,''''  &c.  We  shall  give  as  concise  a  notice  of  the  results 
obtained  by  these  gentlemen  as  the  great  interest  of  the  subject  will  allow. 

And  first,  in  regard  to  the  anatomical  characters  of  the  spinal  nerves. 
It  should  be  borne  in  mind  that  these  nerves  arise  from  the  spinal  cord  at 
points  above  those  of  their  exit  through  the  intervertebral  foramina.  After 
its  exit  each  nerve  divides  immediately  into  two  branches,  the  posterior  of 
which  traverses  the  muscles  at  the  side  of  the  spine,  and  is  distributed  to 
the  skin  of  the  back,  while  the  anterior  runs  forwards  between  the  inter- 
costal muscles,  at  the  middle  line  of  the  side  sends  a  filament  to  the  integ- 
uments, and  then  at  a  point  near  the  sternum,  or  the  outer  edge  of  the 
upper  portion  of  the  external  oblique,  penetrates  the  intercostal  muscles, 
and  is  distributed  to  the  skin  of  the  anterior  part  of  the  thorax,  and  the 
superior  of  the  abdomen.  So  that  we  have  three  superficial  branches; 
1st,  over  the  intervertebral  foramen;  2d,  at  the  middle  of  the  intercostal 
space;  .3d,  near  the  edge  of  the  sternum,  or  of  the  rectus. 

Some  of  these  points  were  found  to  be  painful  in  every  case,  either  with 
pressure  or  without  it,  in  a  space  not  exceeding  half  an  inch,  and  the  ten- 
derness was  occasionally  such  that  the  slightest  touch,  or  raising  of  the 
skin,  gave  rise  to  the  acutest  pain.  When  the  pain  occurred  spontaneously, 
it  generally  commenced  at  the  posterior  point,  and  darted  through  all,  or  a 
part,  of  the  course  of  the  nerve,  though  its  point  of  departure  was  some- 
times either  lateral  or  anterior. 

Taking  together  the  observations  of  both  the  gentlemen  just  mentioned, 
it  appears  that  of  62  cases,  the  disease  was  double  in  20,  on  the  right  side  in 
13,  and  on  the  left  in  29.  The  number  of  intercostal  spaces  affected  varied 
from  one  to  eight,  and  was  noticed  in  those  from  the  fourth  to  the  ninth, 
inclusive,  much  oftener  than  in  the  others.  In  no  case  was  there  any  ap- 
preciable connection  between  the  nervous  disease,  and  that  of  any  of  the 
thoracic  or  abdominal  organs. 

M.  Bassereau,  however,  is  of  opinion  that  the  uterus  and  its  appen- 
dages are  often  to  be  regarded  as  the  primitive  or  starting  point  of  this  variety 
of  neuralgia,  and  this  he  founds  upon  the  frequent  coincidence  of  uterine 
affections  with  it.  On  the  other  hand  it  is  objected,  that  of  females  affect- 
ed with  the  other  forms  of  neuralgia,  more  than  half  were  subject  to  ute- 
rine disturbance  whose  connection  with  the  nervous  complaint,  whether 
as  cause  or  effect,  there  was  no  reason  to  suspect;  and  that  those  men- 
tioned by  M.  Bassereau,  and  who  had  tenderness  of  the  neck  of  the  womb 
and  alteration  of  its  functions,  were  really  sufTering  under  lumbo-abdominal 
neuralgia,  which  was  the  cause,  and  not  the  consequence,  of  the  derange- 
ment of  the  uterus.  Besides  all  this,  the  etiology  in  question  would  of 
course  be  inapplicable  to  males,  of  whom  there  were  eleven  out  of  fifty-six 
patients. 

From  the  short  account,  even  of  the  disease,  here  given,  it  is  plain  that 
it  cannot  easily  be  confounded  with  affections  of  the  lungs  and  pleurae. 
Even  at  the  onset  of  these  latter  the  presence  of  fever  and  cough,  and  the 
absence  of  the  circumscribed  painful  points,  will  prevent  mistakes.  It  is 
less  easy  to  distinguish  intercostal  neuralgia  from  muscular  rheumatism, 
but  the  characters  of  both  have  already  been  noticed.  Some  writers  have 
thought  angina  pectoris  a  form  of  neuralgia,  but  M.  Valleix  does  not 
think  this  doctrine  admissible  in  the  present  state  of  medical  science, 
chiefly  for  the  reason  that  in  all  the  cases  of  intercostal  neuralgia  he  has 
seen  none  of  the  symptoms  of  the  first  named  disease.     The  question, 


106  Reviews,  [July 

however,  is  open.  Certain  diseases  of  the  spinal  marrow  occasion  pains 
more  or  less  confined  to  its  neighbourhood.  In  spinal  meningitis  the  pain 
is  more  acute  and  diffused,  and  is  heightened  by  pressure  upon  the  spi- 
nous processes:  there  are  frequently  convulsions,  permanent  muscular  con- 
tractions, or  tetanus.  The  patients  affected  with  softening  of  the  spinal 
€ord,  have  a  pain,  which,  starting  from  a  fixed  point  of  the  spine,  sur- 
rounds the  abdomen,  or  the  base  of  the  chest,  giving  a  sensation  like  that 
of  a  tight  belt.  Pressure  upon  the  spinous  processes  over  the  diseased 
part  causes  pain,  but  none  is  caused  by  the  same  means  applied  a  little  to 
one  side  or  the  other,  nor  is  there  any  lateral,  nor  anterior  "  point."  In 
caries  of  the  vertebrae,  as  is  well  known,  pain  may  be  excited  in  the  dis- 
eased bone  by  pressing  laterally  on  the  ribs  with  which  it  articulates;  but 
in  neuralgia  the  pain  is  developed,  not  by  pressing  upon  a  rib,  but  in  an 
intercostal  space,  not  at  a  distance  from,  but  at  the  point  where  the  finger 
bears. 

LuMBO-ABDOMiNAL  Neuralgia.- — We  shall  not  dwell  long  upon  this 
variety,  which  is  rare,  and  chiefly  interesting  from  its  identity  with  the 
affection  described  by  Sir  Astley  Cooper  as  irritable  testis.  The  painful 
points  are  the  following;  1st,  the  lumbar,  where  the  posterior  nervous 
branches  reach  the  skin;  2d,  the  iliac,  about  the  middle  of  the  crest  of  the 
ilium;  3d,  the  hypogastric,  just  above  the  external  abdominal  ring;  4th, 
the  inguinal,  about  the  middle  of  Poupart's  ligament;  5th,  the  scrotal  or 
labial,  at  the  lower  end  of  the  testicle,  or  in  the  labium  majus  of  the 
female.  Several  of  these  points  were  painful  in  the  ease  of  a  young  man 
who  attributed  his  sufl^erings  to  a  venereal  excess.  He  began  by  feeling 
in  the  left  testicle  a  pain  which  was  at  first  slight,  but  afterwards  increased, 
it  darted  from  the  testicle  to  the  groin,  and  sometimes  to  the  crest  of  the 
ilium  and  the  loins.  These  four  points  were  all  morbidly  sensitive,  the 
testicle  most  of  all,  and  chiefly  at  the  lower  part  of  the  epididymis.  There 
was  nothing  remarkable  about  the  size  of  this  organ,  nor  in  the  colour  and 
thickness  of  the  skin  of  the  scrotum. 

Crural  Neuralgia  is  rarely  met  with  alone,  but  most  frequently  com- 
plicated with  sciatica.  It  is  seated  in  the  anterior  crural  nerve,  or  its 
branches.  At  its  origin  this  nerve  is  intimately  connected  with  the  sciatic 
plexus;  it  is  superficial  at  the  groin,  about  the  middle  of  the  sartorius,  over 
the  internal  condyle,  around  the  malleolus  internus,  and  at  the  inner  side 
of  the  sole  of  the  foot.  In  all  these  points  pain  has  been  felt,  either  when 
spontaneous,  or  developed  by  pressure. 

Femoro-popliteal  Neuralgia.  (Sciatica.)— Since  the  time  of  Cotun- 
nius,  very  little  addition  has  been  made  to  our  knowledge  of  the  pathology 
of  sciatica.  The  disease  has  been  studied  chiefly  with  a  view  of  perfect- 
ing its  treatment.  M.  Valleix  thinks,  however,  that  there  was  room  for 
improvement  in  both  of  these  points,  and  he  has  endeavoured  to  do  his 
part  towards  it.  The  materials  for  his  essay  upon  this  variety  of  neural- 
gia consist  of  125  cases  in  all,  of  which  89  are  collected  from  various 
authors,  15  observed  by  himself,  and  21  by  M.  Louis.  These  last,  our 
author  observes,  although  recorded  in  1813-14,  are  much  more  carefully 
drawn  up,  and  furnish  more  exact  details,  than  most  of  those  recently 
published. 

M.  V.  considers  the  afl^ection  not  only  as  it  shows  itself  in  the  sciatic 
nerve,  properly  so  called,  but  also  in  the  branches  of  the  sacral  plexus  of 
which  itself  is  the  terminating  branch.     The  most  important  of  these,  for 


1842.]  YaXle'ix  on  Neuralgia.  107 

our  present  purpose,  are  those  which,  outside  of  the  sciatic  notch,  form 
the  gluteal  plexus,  and  send  superficial  filaments  upwards  to  the  attach- 
ment of  the  gluteus  maximus  to  the  crest  of  the  ilium,  and  a  cutaneous 
branch,  which,  after  forming  loops  near  the  tuberosity  of  the  ischium, 
sends  down  the  back  of  the  thigh  branches  which  extend  to  either  condyle, 
and  are  covered  only  by  the  crural  aponeurosis.  The  sciatic  nerve  lies 
deeply  under  the  muscles  until  it  approaches  the  ham.  Here  it  gives  off; 
1st,  the  peroneal  nerve,  which  is  superficial  in  the  ham  and  around  the 
neck  of  the  fibula,  and  which  supplies  the  external  malleolus,  and  the  back 
of  the  foot;  2d,  the  communicating  tibial,  which  is  superficial  at  the  mid- 
dle and  lower  part  of  the  calf,  and  lies  along  the  outer  side  of  the  tendo- 
achillis,  and  the  external  malleolus;  3d,  the  lower  part  of  the  posterior 
tibial  nerve  lying  along  the  inner  side  of  the  great  tendon,  and  behind  the 
internal  malleolus. 

In  one  or  more  of  the  following  points  there  was  a  constant  pain,  which 
was  always  aggravated  by  pressure.  1st.  In  the  region  of  the  hip,  in 
thirty-six  cases,  pain  was  found  at  the  posterior  superior  spine  of  the 
ilium,  35  times;  at  the  middle  of  tiie  crest,  8  times;  at  the  upper  part  of 
the  sciatic  notch,  16  times;  at  the  great  trochanter,  26  times.  2d.  On  the 
thigh.  In  thirty  cases  the  pain  occupied  the  whole  length  of  the  thigh, 
though  it  was  most  acute  about  the  tuberosity  of  the  ischium,  at  the  middle 
of  the  member,  and  a  little  within  the  insertion  of  the  biceps.  These 
three  points  were  the  only  seats  of  pain  in  a  few  cases,  and  to  them  the 
patients,  of  their  own  accord,  referred  their  suff'ering.  3d.  The  knee  was 
painful  in  its  whole  extent  in  17  cases,  but  especially  so  at  the  outer  part 
of  the  ham,  and  at  the  head  of  the  fibula:  these  points  were  alone  affected 
in  9  cases.  4th.  Jn  the  leg.  The  whole  length  of  the  fibula  was  painful 
in  9  cases,  in  three  of  which  there  were  points  of  remarkably  acute  pain 
just  above  the  malleolus,  and  at  the  middle  of  the  bone.  28  patients  com- 
plained of  pain  along  the  posterior  edge  of  the  fibula;  at  the  septum  of  the 
two  bellies  of  the  gastrocnemius,  in  15  cases,  and  a  little  exterior  to  the 
spine  of  the  tibia  in  five  cases,  there  was  pain.  5th.  The  foot,  including 
the  malleoli,  was  afi'ected  in  25  cases,  and  over  its  whole  surface  in  8 
cases,  in  7  of  these,  however,  the  greatest  uneasiness  was  felt  behind  the 
external  malleolus.  The  toes,  the  internal  malleolus,  and  the  sole  of  the 
foot  were  occasionally  painful;  the  posterior  tibial  which  supplies  these 
regions  is  not  so  superficial  as  the  peroneal  nerve,  a  fact  which  is  suffi- 
cient to  explain  the  comparative  exemption  of  the  former  from  neuralgia. 

Sciatica  is  the  most  common  form  of  neuralgia  after  the  dorso-intercostal 
variety.  It  is  rare  in  childhood,  and  is  oftener  seen  in  men  than  in  women. 
It  sometimes  accompanies  affections  of  the  spinal  marrow.  Our  author 
has  never  observed  it  as  a  metastastic  disease,  nor  as  a  consequence  of 
venereal  infection;  he  thinks  it  sometimes  depends  upon  disorders  of  the 
menses,  and  that  its  immediate  cause,  when  discoverable,  is  oftener  severe 
cold  than  any  thing  else.  The  lancinating  pains  so  generally  thought 
essential  to  this  disease,  existed  in  all  the  cases  indeed,  but  not  at  all  stages 
of  them.  In  the  beginning,  the  pain  was  usually  dull,  and  exasperated  by 
every  movement;  in  the  middle  part  of  the  course  of  the  disease,  the  lan- 
cinations  were  observed  in  every  one  of  M.  V.'s  cases,  but  they  disap- 
peared during  its  decline.  In  16  out  of  36  cases  the  lancinations  followed 
the  course  of  the  nerve,  in  5  they  ascended  or  descended,  and  in  11  were 


108  Reviews.  [July 

fixed  and  disseminated.     M.  Louis  noted  the  absence  of  this  symptom  in 
3  out  of  21  cases. 

Besides  this  sensation  many  patients  suffered  from  others  of  a  different 
description.  Generally,  there  was  a  feeling  of  cold  in  the  usual  seat  of 
the  pain,  but  no  appreciable  difference  in  the  temperature  of  the  two  sides 
of  the  body.  It  most  frequently  occurred  in  the  winter  season,  and  on 
retiring  to  bed.  In  three  cases  there  was  a  sensation  of  intense  heat  in 
the  part;  in  one  an  intolerable  itching,  and  in  numerous  instances  local 
shiverings. 

In  a  few  cases  there  were  cramps  either  upon  coming  out  of  a  bath,  get- 
ting into  bed,  or  during  the  violence  of  the  paroxysms.  Convulsions 
occurred  in  one  case  only,  and  that  of  very  long  standing.  M.  Valleix 
has  not  often  met  with  atrophji^  of  the  affected  limb,  as  described  by  pre- 
vious authors,  and  he  is  inclined  to  ascribe  it,  when  found,  to  the  long 
inaction  imposed  by  the  intensity  of  the  pain.  Sciatica  is  very  rarely  of 
a  strictly  intermittent  character.  This,  like  other  forms  of  neuralgia,  is 
readily  confounded  with  muscular  rheumatism.  It  may  also  be  mistaken 
for  coxalgia  in  its  early  stages.  But  in  the  latter  disease,  although  the 
patient  complains  of  pain  in  the  knee,  there  is  not,  upon  pressure,  any 
morbid  sensibility  in  it;  the  period  of  life  also  is  to  be  taken  into  account; 
the  constitution  of  the  patient,  the  exact  seat  of  the  pain  in  the  hip,  that 
on  moving  the  limb,  the  accompanying  symptoms  of  fever,  &c.  Sciatica 
has  sometimes  been  confounded  with  paraplegia,  and  with  neuritis:  after 
what  has  been  said,  it  is  needless  to  insist  further  upon  distinctions  which 
every  cautious  observer  will  perceive. 

Treatment  of  Neuralgia. — M.  Valleix  believes  the  usefulness  o^  nar- 
cotics to  be  entirely  limited  to  their  paUiative  influence  during  the  parox- 
ysms. Physicians  who  have  thought  they  had  a  curative  effect,  perhaps 
did  not  consider  that  the  slighter  attacks  of  the  disease  often  get  well  with- 
out any  medical  interference.  The  suhcarhonate  of  iron  was  not  given 
alone  in  many  of  the  cases  which  our  author  has  analysed;  he  cannot, 
therefore,  express  a  positive  opinion  concerning  it.  From  what  we  know 
of  the  properties  of  the  preparations  of  iron,  it  would  seem  probable  that 
their  influence  upon  neuralgia  must  be  indirect,  and  greatest  in  cases  where 
there  is  also  anemia.  Very  few  of  M.  V.'s  patients  appear  to  have  had 
any  disease  but  neuralgia;  other  physicians  more  frequently  find  it  com- 
plicated; and  this  may,  perhaps,  explain  why  our  author  speaks  so  dispa- 
ragingly of  internal  treatment  in  general.  Sulphate  of  quinine  was  tried 
in  18  cases  where  there  appeared  every  indication  for  its  use;  the  result 
was  6  cured,  and  2  relieved.  The  pills  of  Meglin  (composed  of  equal 
parts  of  extract  of  henbane,  powdered  valerian,  and  oxide  of  zinc,)  have 
been  most  frequently  used  in  trifacial  neuralgia,  and  they  are  thought  to 
have  been  useful  in  some  cases,  but  were  occasionally  given  by  their 
inventor  in  doses  which  a  prudent  physician  would  certainly  hesitate  to 
prescribe.  The  oil  of  turpentine  has  been  greatly  extolled  for  its  cures  of 
neuralgia,  and  especially  of  sciatica.  The  fullest  account  of  its  use  is  to 
be  found  in  the  work  of  Martinet,  of  whose  cases,  M.  Valleix  has  made 
a  minute  analysis  relatively  to  the  point  in  question.  His  conclusion  is, 
that  this  remedy  has  been  too  highly  praised  by  some,  and  too  much  de- 
preciated by  others;  that  among  the  cases  of  Martinet  there  are  some  where 
a  cure  was  effected,  in  from  six  to  ten  days  and  sometimes  less,  of  persons 
who  had  suffered  for  months  under  sciatica,  for  which  other  treatment  had 


1842.]  YaWeix  on  Neuralgia.  lOD 

been  vainly  tried;  and  that  all  the  negative  facts  in  the  world  cannot  deprive 
these  positive  ones  of  their  full  value.  The  administration  of  oil  of  tur- 
pentine, however,  requires  caution. 

The  actual  cautery,  the  section  of  the  nerve,  electricity,  and  several 
other  modes  of  treatment  are  examined  at  length  in  the  work  before  us. 
The  first  two  are  set  aside,  the  one  on  account  of  its  cruelty,  and  the  other 
for  its  ordinary  inefficacy  in  addition.  The  third  agent  is  not  considered 
by  our  author  as  worthy  of  the  confidence  which  has  been  placed  in  it  by 
M.  Magendie. 

Blisters  have  been  used  in  the  treatment  of  neuralgia  by  a  great  many 
physicians,  since  the  time  of  Cotunnius.  One  of  the  latest  .writers  on 
the  disease,  (Dr.  Bennett,  in  the  "  Library  of  Practical  Medicine,")  says, 
*'  Blisters  have  been  occasionally  applied,  but  the  opinion  of  Dr.  Heberden, 
that  they  are  calculated  to  aggravate  superficial  neuralgia,  is  supported  by 
recent  experience,  and  their  employment  is  now  almost  confined  to  the 
treatment  of  sciatica."  The  result  of  our  author's  "  recent  experience"  is 
rather  different.     He  says — 

*'  It  is  evident  that  if  something  more  remains  to  be  done  for  the  treatment  of 
this  affection,  the  facts  which  I  have  brought  together  are  sufficient  to  prove  the 
efficacy  of  certain  means,  and  chiefly  blisters,  especially  flying  blisters  applied 
upon  the  painful  points.  New  observations  prove  to  me  every  day  that  this  is 
the  treatment  ;jar  excellence,  when  there  is  no  special  indication  opposed  to  it." 

In  another  place  he  mentions  that  blisters  formed  the  basis  of  treatment 
in  fifty-two  cases:  thirty-nine  of  them  were  cured,  seven  relieved,  and  six 
unaffected  by  them.  These  last  mentioned  cases  were  not  treated  as  perse- 
veringly  as  they  should  have  been. 

The  account  given  by  M.  Valleix,  of  this  medication,  when  speaking  of 
the  treatment  of  sciatica,  is  so  interesting  that  we  offer  no  apology  for 
presenting  an  abstract  from  it. 

"  The  blisters  were  dressed  with  epispastic  ointment,  which  occasioned  a 
keen  smarting,  and  often  an  increase  of  the  pains.  In  the  cases,  too,  v/hich  got 
well,  it  was  not  till  several  days  after  the  dressings  were  applied,  and  when  the 
denuded  surface  was  less  tender,  that  the  improvement  commenced.* ***The 
reflections  sugg^ested  by  these  facts  led  me  to  continue  the  use  of  blisters,  by 
increasing  their  number  without  keeping  up  their  discharge,  and  by  applying 
them  over  all  the  points  where  pain  existed,  or  could  be  developed  by  pressure. 
I  employed  this  method  with  all  the  patients  I  had  to  treat,  of  whatever  form 
their  neuralgia.****Will  this  means  always  succeed?  That  may  not  yet  be 
affirmed.  But  it  should  not  be  forgotten  that  in  all  therapeutic  questions  rela- 
tive to  diseases  of  active  and  marked  symptoms,  it  is  not  only  important  to  in- 
quire whether  or  not  the  treatment  cured  the  disease,  but  v*^hether  it  acted  in  a 
rapid  and  direct  manner  upon  the  principal  symptoms,  and  it  is  by  keeping  in 
mind  this  latter  influence,  that  I  have  been  struck  with  the  beneficial  effects  of 
numerous  flying  blisters  in  neuralgia. 

"  Cotunnius,  as  is  well  known,  was  a  great  admirer  of  the  treatment  by  blisters; 
he  proposed,  by  employing  this  exutory,  to  evacuate  the  morbific  humour  he 
imagined  to  exist  within  the  sheath  of  the  nerve.  He  sought  the  most  favour- 
able point  for  fulfilling  this  indication,  and  [for  sciatica]  thought  he  had  found 
it  over  the  head  of  the  fibula.  But  he  did  not  confine  his  blister  to  this  spot, 
he  extended  it  across  the  popliteal  space,  and  the  tibia,  exactly  over  the  parts 
where  the  existence  of  spontaneous  or  excited  pain,  now  indicates  the  applica- 
tion of  the  same  remedy.  Moreover,  he  did  not  use  any  stimulating  dressings 
to  keep  his  blisters  open.  The  success  he  obtained  was  such  that  he  feared  to 
be  accused  of  boasting,  if  he  proclaimed  it.  Yet  Cotunnius  had  not  adopted 
No.  Vn.— July,  1842.  10 


110  Reviews.  ^  •  [July 

the  above  named  points  for  the  application  of  blisters,  to  the  exclusion  of  all 
others.  He  was  often  obliged  to  place  them  upon  other  portions  of  the  nerve, 
and,  by  a  happy  coincidence,  his  theory  led  him  to  select  those  which  are  the 
most  constant  seats  of  pain,  viz.  the  external  malleolus,  the  instep,  the  head  of 
the  fibula,  and  the  outer  edge  of  the  ham.  We,  who  cannot  admit  a  theory 
having  no  foundation  in  facts,  may  yet  profit  by  the  results  of  experience.  We 
should  be  guided  in  our  selection  of  the  points  for  applying  blisters,  by  the 
statements  of  the  patient  and  by  an  accurate  search  for  painful  spots,  according 
to  the  principles  already  laid  down,  and,  in  case  an  exceptional  point  should  be 
discovered,  ought  to  treat  it  like  an  ordinary  one.  The  number  of  blisters  to  be 
applied  at  the  same  time  must  be  settled  by  the  practitioner,  according  to  the 
intensity  of  the  disease,  and  the  number  of  the  painful  points.  In  severe  cases 
I  have  applied  three  at  a  time,  each  of  them  about  an  inch  in  diameter." 

We  have  attempted  to  make  such  an  analysis  of  the  treatise  of  M.  Valleix 
as  should  present  his  own  discoveries  distinct  from  the  historical  and 
critical  portions  of  the  work.  But  in  doing  this,  we  have,  in  order  to 
avoid  prolonging  this  article  unduly,  been  obliged  to  give  very  litde  more 
than  an  abstract  of  the  author's  own  abstracts.  Besides  incidentally  con- 
tributing to  the  settlement  of  a  great  many  questions  relative  to  the 
symptomatology  of  the  disease,  M.  Valleix  has  established  two  very 
important  propositions,  viz.  1st,  That  neuralgia  exists  in  the  most  super- 
ficial portions  only  of  the  spinal  nervous  system,  where  it  can  be  detected 
by  pressure  upon  the  affected  nerves;  and  2d,  That  the  most  certain,  and 
the  speediest  cure  for  it  is  flying  blisters  applied  over  the  various  painful 
points  in  the  course  of  the  nerves.  It  should  be  recollected  that  these  are 
not  opinions,  that  they  are  not  hasty  inferences  from  imperfectly  registered 
or  only  remembered  cases;  but  that  they  are  logical  inductions  from  cases 
minutely  and  honesdy  studied,  and  recorded  when  observed.  They  have 
a  value  entirely  irrespective  of  the  talents  or  the  reputation  of  M.  Valleix, 
although  it  required  the  patience  and  yet  the  earnestness  of  a  lover  of 
truth,  to  develop  them  from  out  of  the  vast  mass  of  materials  that  had 
been  collected. 

We  are  not  disposed  to  criticise  a  work  which  is  so  fruitful  in  good. 
We  hope  that  some  one  may  be  found  willing  to  undertake  its  translation 
into  English,  both  for  the  sake  of  the  valuable  information  it  contains, 
and  for  its  excellence  as  a  model  for  future  observers.  We  have  yet  much 
to  learn  about  the  functional  diseases  of  the  nervous  system,  and  the  plan 
of  study  pursued  by  our  author  may  perhaps  be  found  still  farther  appli- 
cable to  them.  A.  S. 


Art.  XI. — The  Climate  of  the  United  States  and  its  Endemic  In- 
fluences. Based  chiefly  on  the  Records  of  the  Medical  Department' and 
Adjutant  GeneraVs  Office,  United  States  Army. — By  Samuel  Forry, 
M.D.     New  York,  1842:  8vo.  pp.  378. 

The  merit  of  being  the  first  to  establish,  on  an  extensive  scale,  the  re- 
cording and  collecting  of  meteorological  observations,  with  the  view  of  im- 
proving our  knowledge  of  the  climate  of  the  United  States,  is  we  believe 
due  to  the  late  Surgeon  General  of  the  United  States  Army,  Dr.  liOvell, 
who  about  twenty  years  ago  issued  instructions  to  the  surgeons  at  the  different 
posts  to  keep  regular  records  of  the  weather,  and  transmit  them  to  the  de- 


1842.]  Forry  on  the  Climate  of  the  United  States,  111 

partraent  at  Washington;  and  in  1826  he  published   the  results  of  these 
observations  for  the  preceding  four  years. 

The  first  state  that  adopted  measures  to  obtain  meteorological  obser 
vations  from  its  various  sections,  was  New  York,  where  the  academies 
and  other  schools  established  under  legislative  patronage  have  been  bound, 
for  many  years  past,  to  keep  meteorological  registers,  and  make  reports 
of  the  results  to  the  Regents.  The  legislature  of  Pennsylvania,  in  1836, 
made  a  liberal  appropriation  for  similar  purposes,  by  means  of  which 
each  county  in  the  state,  fifty-four  in  number,  is  supplied  with  a  set 
of  meteorological  instruments,  with  which  observations  have  been  made 
and  reported  monthly  to  a  special  committee  of  the  Franklin  Institute 
at  Philadelphia,  where  they  can  be  consulted  at  all  times  by  persons  en- 
gaged in  meteorological  investigations.  Ohio  has  within  the  last  year 
come  into  a  similar  measure,  so  that  we  have  now  a  very  extensive  dis- 
trict of  country  embraced  within  the  borders  of  New  York,  Pennsylvania 
and  Ohio,  covered,  as  it  were,  with  points  of  instrumental  meteorological 
observation.  When  to  these  efforts  of  individual  states  we  add  those  of  the 
Medical  Bureau  of  our  army,  embracing  observations  not  only  at  posts  with- 
in the  older  settlements,  but  also  at  those  in  the  most  remote  parts  of  our 
territories;  and  also  those  made  under  the  direction  of  the  British  authori- 
ties in  their  extensive  possessions,  it  may  be  said  that  in  future  little  want 
can  be  experienced  of  meteorological  data,  by  which  the  progress  of 
storms,  and  all  the  great  atmospheric  movements  can  be  traced  through 
the  North  American  Continent.  To  those  engaged  in  solving  the  intrica- 
cies of  meteorological  phenomena,  the  importance  of  such  means  of  in- 
formation need  not  be  dwelt  upon. 

It  is  therefore  with  particular  pleasure  that  we  hail  the  treatise  before 
us,  a  pleasure  which  we  are  sure  will  be  reciprocated  at  large  by  our  medi- 
cal brethren,  who  cannot  fail  to  appreciate  the  value  of  such  a  collection 
of  authentic  matter  in  relation  to  the  climatology  of  our  country,  from  the 
oldest  settlements  on  the  Atlantic  coasts,  to  the  farthest  out-posts  of  civi- 
lized occupation,  even  to  the  shores  of  the  Pacific.  The  volume  is  very 
appropriately  dedicated  to  Dr.  Lawson,  Surgeon  General  of  the  United 
States  Army,  under  whose  direction  the  investigation  of  the  subject  was 
first  undertaken  by  tlie  author  in  the  "  Army  Meteorological  Register," 
and  the  "  Statistical  Report  of  the  sickness  and  mortality  of  the  army  of 
the  United  States,"  both  of  which  publications  we  have  already  had  occa- 
sion to  notice  favourably  in  this  Journal. 

The  authentic  materials  employed  in  the  composition  of  the  volume  be- 
fore us  have  required  years  to  collect,  and  years  to  collate  and  digest. — 
All  this  labour  has  been  accomplished  through  the  design  and  execution, 
by  members  of  the  medical  profession.  Dr.  Forry's  work  may  therefore 
be  regarded  as  a  new  contribution  to  science  by  that  faculty  which  fur- 
nishes by  far  the  largest  proportion  of  labourers  in  the  field  of  philosophi- 
cal research. 

Dr.  Forry  divides  his  work  into  two  general  divisions  or  parts.     'J'he 

Jirst  division  is  devoted  to  the  elucidation  of  the  laws  of  climate  in  general, 

and   especially    to  the   climatology    of  the   United   States,     'i'he   second 

division  treats  of  the  endemic  influences  peculiar  to  the  systems  of  climate 

developed  in  the  first  part. 

In  accordance  with  the  motto  derived  from  Malte  Brun,  that  "  the  best 
observations  upon  climate  often  lose  half  their  value   for  the   want  of  an 


112  Reviews.  [Wy 

exact  description  of  the  surface  of  the  country,"  our  author  gives  a  bold 
outline  of  the  physical  features  of  the  United  States  and  territories,  stretch- 
ing from  the  Atlantic  to  the  Pacific  Oceans,  and  from  the  Gulf  of  Mexico 
to  the  Northern  inland  seas. 

1.  The  Atlantic  Plain,  is  viewed  as  shghtly  elevated  above  the  sea,  gra- 
dually widening  from  a  {ew  miles  in  the  North,  to  upwards  of  150  miles 
in  the  South.  This  alluvial  zone,  sloping  gently  to  the  ocean,  has  in 
many  places  extensive  marshes,  swamps,  sluggish  streams,  and  innume- 
rable inlets  from  the  sea.  The  deposits  swept  by  the  mighty  rivers 
into  the  tide-water  region,  afford  but  too  many  sources  of  noxious  efflu- 
via, or  miasmata. 

2.  The  Apalachian  range  of  mountains  terminating  this  plain,  has  a 
mean  altitude  above  the  sea  of  about  2500  feet,  with  crests  rising  occa- 
sionally to  the  height  of  3000  feet.  Its  spurs  separate  from  each  other  so 
as  to  form  extensive  valleys  of  great  beauty  and  fertility,  having  an  ave- 
rage elevation  of  1000  or  1200  feet  above  the  ocean.  The  western  de- 
clivity of  this  Apalachian  or  Alleghany  range,  descends  into  the  great  Mis- 
sissippi plain  or  basin,  extends  through  the  centre  of  the  continent  from 
the  Gulf  of  Mexico  to  the  Arctic  Sea,  and  stretches  westward  to  the  Rocky 
Mountains  or  Great  Chippewayen  range.  This  vast  valley  is  computed  to 
contain  not  less  than  3,250,000  square  miles,  and  is  undoubtedly  the 
largest  continuous  body  of  lands  of  the  highest  natural  fertility  to  be  found 
on  the  globe.  It  already  counts  its  millions  of  inhabitants,  and  is  destined 
in  the  order  of  nature  to  rival,  even  perhaps  excel,  in  population  the  teeming 
plains  of  India  and  China.  The  grand  mountain  chain  into  which  the 
Mississippi  valley  rises  on  the  west,  called  by  the  various  appellations  of 
Rocky,  Chippewayen,  and  Oregon,  is  a  prolongation  of  the  Andes,  or 
Mexican  Cordilleras.  Rising  from  a  common  base  of  about  3000  feet 
above  the  level  of  the  sea,  the  average  height  of  the  summits  above  the 
base  is  set  down  at  5000  feet,  some  of  the  crests  being  not  less  than  8,000 
or  10,000  feet  above  the  adjacent  country. 

Beyond  this  bold  chain  and  still  farther  west,  we  find  the  range  of  the 
Pacific  coast,  properly  called,  stretching  northward  from  the  peninsula  of 
California.  They  are  from  80  to  100  miles  distant  from  the  ocean,  and 
have  peaks  rising  even  above  the  most  elevated  of  the  Rocky  Mountains, 
some,  we  are  informed  being  10,000,  15,000,  and  even  18,000  feet  above 
the  level  of  the  sea.  The  summits  of  these  as  well  as  those  of  the  Rocky 
range,  must  necessarily  be  above  the  line  of  perpetual  congelation.  Thus 
is  the  territory  of  the  United  States  geographically  divided  by  two  great 
systems  of  mountains  into  three  natural  subdivisions,  namely,  the  Atlantic 
table-land  and  plain,  the  Mississippi  valley,  and  the  Pacific  region. 

To  this  view  of  the  geographical  systems  into  which  the  United  States 
and  territories  are  naturally  divided  by  mountain  ranges  of  sufficient  eleva- 
tion to  produce  modifications  of  climate,  a  description  of  the  general  cha- 
racter of  the  surface  at  the  present  day,  may  be  appropriately  added,  in 
the  words  of  our  author. 

"  From  the  shores  of  the  Atlantic  to  the  Mississippi,  there  is  presented  an  im- 
mense natural  forest,  interspersed  with  open  and  naked  plains,  called  prairies^ 
which  are  numerous  west  of  the  Alleghanies,  but  very  rare  on  the  Atlantic  side. 
The  country  west  of  the  Mississippi  is  comparatively  lightly  wooded;  and  in 
the  arid  and  desert  plains,  occupying  a  breadth  of  300  or  400  miles,  only  a  few 
trees  are  seen  along  the  margins  of  the  rivers.     In  that  portion  of  the  United 


1842.]  Forry  on  the  Climate  of  the  United  States.  113 

States  which  is  inhabited,  the  land  cleared  and  cultivated  does  not  probably  ex- 
ceed one-tenth  part  of  its  surface." 

Various  portions  of  the  United  States  and  territories  present  charac- 
teristics sufficiently  marked  to  justify  a  division  and  classification  of  cli- 
mates. But  previous  to  considering  the  local  circumstances  which  exert 
modifying  influences,  we  think  it  proper  to  invite  attention  to  what  we 
regard  as  the  great  principle  of  climatology. 

If  the  phenomena  of  terrestrial  and  atmospheric  temperature  which  con- 
stitute the  most  prominent  elements  of  climate,  depended  solely  upon  the 
position  of  the  earth  in  relation  to  the  sun,  then  would  there  be  such  a  uni- 
formity in  the  climates  of  countries  in  similar  latitudes  as  to  render  it  easy 
to  classify  them  according  to  their  respective  distances  from  the  equator  or 
proximity  to  the  poles.  But  observations  made  in  different  parts  of  the 
world  show  that  in  similar  latitudes  climates  differ  greatly,  as  is  exempli- 
fied on  the  two  sides  of  the  northern  Atlantic,  where  the  mean  tempera- 
tures of  places  on  or  near  the  ocean  are  found  to  differ  in  some  cases  10 
degrees  of  Fahrenheit,  the  climate  of  the  European  coast  being  that  much 
warmer  than  the  American  in  the  same  latitude.  When,  instead  of  mean 
temperatures,  extremes  of  heat  and  cold  are  compared,  the  difference  is 
still  more  striking. 

Now,  in  explaining  the  rationale  of  this  well  known  fact,  we  are  com- 
pelled to  refer  to  a  grand  natural  phenomenon,  which  we  shall  designate 
the  great  Atmospheric  circulation.  This  commences  in  the  tropical  region 
where  the  accumulated  heat  of  the  sun  rarefies  the  air,  which,  ascending 
into  the  higher  regions  of  the  atmosphere,  flows  off  towards  the  North  and 
South.  To  compensate  for  the  loss  by  this  successive  flowing  off  of  the 
heated  and  rarefied  portion,  and  maintain  that  equilibrium  which  the  baro- 
meter informs  us  always  subsists  in  the  atmosphere  throughout  the  globe, 
lower  currents  of  heavier  air  sweep  into  the  tropical  regions  from  the 
northward  and  southward.  These  last  have  been  denominated  the  polar 
currents,  whilst  the  uppermost  are  designated  as  the  tropical  currents;  and 
these,  it  is  well  known,  do  not  flow  directly  north  or  south,  but  slantwise, 
a  fact  which  is  ascribed  to  the  influence  exerted  by  the  motion  of  the  globe 
upon  its  axis,  and  the  diflerent  velocities  existing  at  different  parts  of  its 
surface.  Owing  therefore  to  the  combined  agencies  of  solar  heat,  and 
diurnal  rotation,  the  lower  winds  in  the  equatorial  region  have  a  slanting 
direction  from  the  eastward  constituting  the  Trade  Winds,  which  blow  the 
year  round  between  the  tropics,  except  where  changed  into  Monsoons  by 
the  interposition  of  some  influences  by  which  a  change  is  wrought  in  their 
direction  during  six  months  of  the  year.  Whilst  the  winds  within  the 
tropics  thus  blow  interminably  from  the  eastward,  those  without  the  tro- 
pical limits  have  a  prevailing  direction  from  the  west.  Here  then  we  find 
the  solution  of  the  problem,  that  in  extra-tropical  latitudes  all  countries 
situated  to  the  eastward  of  seas  or  other  great  bodies  of  water,  have  milder 
climates  than  those  occupying  the  eastern  portions  of  continents.  Large 
bodies  of  water  never  become  so  cold  in  winter  or  so  warm  in  summer  as 
the  earth.  Hence  whenever  the  predominant  winds  sweep  from  the  sea, 
they  carry  with  them  the  temperature  of  the  water  to  a  greater  or  less 
distance  inland,  and  thus  obviate  extremes.  When,  however,  the  pre- 
vailing winds  pass  over  large  tracts  of  country,  they  must  necessarily  bear 
with  them  the  greater  or  less  degrees  of  cold  induced  by  congelation,  and 

10* 


114  Reviews,  [July 

still  more  through  radiation,  whilst  in  summer  they  will  convey  the  accu- 
mulated heat  absorbed  by  the  earth.  This  view  enables  us  to  understand 
why  the  proximity  of  the  Gulf  Stream, — that  mighty  lake  of  warm  water, 
as  Major  Reynell  calls  it,  not  inferior  in  size  to  the  Mediterranean, — does 
not  shed  upon  the  shores  of  the  United  States  a  larger  portion  of  its 
high  temperature,  the  greatest  proportion  of  the  warmth  communicated  by 
it  to  the  atmosphere  being  actually  wafted  to  the  distant  shores  of  Eu- 
rope. 

The  celebrated  Humboldt,  who  has  devoted  so  much  attention  to  the 
investigation  of  climate,  and  especially  to  the  laws  and  agencies  concerned 
in  the  distribution  of  heat  over  the  surface  of  the  globe,  has  formed  a  system 
of  lines  of  equal  temperature  encircling  the  globe,  and  passing  through  places 
having  the  same  mean  temperature,  either  throughout  the  year  or  during 
particular  seasons.  Those  passing  through  places  having  similar  annual 
means  are  called  isothermal  lines.  As,  however,  it  is  frequently  found 
that  where  the  annual  temperatures  agree  there  is  a  great  difference  in  the 
means  of  particular  seasons,  other  lines  have  been  drawn  to  show  this, 
such  as  pass  through  places  having  equal  summer  temperatures  being 
called  isotheral,  and  those  representing  equal  winter  means  isocheimal 
lines. 

These  lines,  which  from  their  generally  crooked  forms  are  also  called 
curves^  demonstrate  to  the  eye  in  a  striking  manner  the  well  known  fact, 
that  the  distribution  of  temperature  on  both  sides  of  the  equator  is  by  no 
means  in  exact  conformity  to  latitude  or  distance  from  the  equinoctial  line. 
Let  us,  for  example,  take  Humboldt's  isothermal  line  drawn  through 
different  points  around  the  globe,  having  a  mean  annual  temperature 
of  55°. 40  Fahr.,  and  we  shall  find  it  in  the  eastern  part  of  North  Ame- 
rica passing  near  Philadelphia,  in  lat.  39°. 56;  in  the  eastern  part  of 
Asia,  near  Pekin,  in  the  same  latitude  with  Philadelphia;  whilst  on  the 
w'estern  side  of  Europe  it  runs  near  Bourdeaux,  in  lat.  45''. 46;  and  on  the 
western  coast  of  N.  America,  it  is  found  at  Cape  Foul  weather,  a  little 
south  of  the  mouth  of  the  Columbia  river,  latitude  44°.40.  Between  the 
western  part  of  Europe  and  the  eastern  portion  of  N.  America,  the  follow- 
ing differences  in  mean  temperature  are  found  in  similar  latitudes,  the 
increase  in  latitude  being  attended  by  a  very  great  increase  in  the  difference 
of  the  means: 


latitude. 

Mean  Temp,  of  E. 

Mean  Temp.  Western 

Differences  in 

coast  of  N.  Am, 

coast  of  Europe. 

mean  temp. 

30° 

66°.92 

70°.52 

3°.60 

40° 

54°.50 

63°.14 

8°.64     , 

50° 

37°.94 

50°.90 

12°.96 

60° 

23°.72 

40°.60 

16°.92 

Now  all  the  great  variations  in  the  lines  of  equal  temperature  are 
mainly  dependent  upon  the  operation  of  those  extensive  natural  move- 
ments which  we  have  styled  the  great  atmospheric  circulation.  "  The 
causes  of  climate,"  our  author  remarks,  "  constitute  together  a  circle  of 
which  we  can  designate  neither  the  first  nor  the  last  concatenation."  For 
ourselves,  we  find  no  difficulty  in  determining  what  may  be  considered 
the  beginning  link  of  the  chain  connecting  nearly  all  the  grand  phenomena 
of  climatology,  which  is  doubtless  the  atmospheric  rarefaction  induced  in 
the  equatorial  region  through  solar  influence. 


1842.]  Forry  on  the  Climate  of  the  United  States.  115 

After  this  consideration  of  the  great  general  agent  in  the  production  of 
climate,  we  will  proceed  to  notice  a  few  of  those  circumstances  which  are 
well  known  to  exert  more  or  less  important  effects  upon  the  distribution 
of  heat.  One  of  the  principal  of  these,  is  elevation  above  the  level  of  the 
sea.  Meteorologists  compute  that  the  temperature  of  the  atmosphere  falls 
off  or  grows  colder  in  ascending  above  tide-water,  at  the  rate  of  1°  Fahr. 
for  every  100  yards,  or  300  feet.  In  cool  countries  it  would  require,  even 
in  summer,  but  a  slight  ascent  to  reach  the  elevation  where  a  temperature 
at  and  above  32°,  fixes  the  line  of  perpetual  congelation.  But  in  warm 
regions,  such  as  those  within  or  bordering  upon  the  tropics,  the  line  of 
perpetual  snow  is  elevated  some  14,000  or  16,000  feet  above  the  level  of 
the  ocean. 

Whenever  land  rises  high  above  the  common  sea-level,  it  induces  a 
change  of  climate  similar  in  its  effects  upon  the  distribution  of  tempera- 
ture, and  the  consequent  distribution  of  plants,  to  increase  of  latitude. 
The  phenomena  thus  induced  upon  the  products  of  the  vegetable  world 
are  strikingly  exhibited  in  the  stupendous  mountains  which  in  central 
America  tower  above  the  common  level  of  the  ocean. 

In  reference  to  the  diminution  of  temperature  resulting  from  the  eleva- 
tion of  land,  our  author  makes  the  following  interesting  observations. 

"  Whilst  the  flowers  of  spring  are  unfolding  their  petals  on  the  plains  of 
northern  France,  winter  continues  his  icy  reign  upon  the  Alps  and  Pyrenees. 
By  this  beneficent  appointment  of  nature,  the  torrid  zone  presents  many  habita- 
ble climates.  On  the  great  table-plain  of  Mexico  and  Guatimala,  a  tropical  is 
converted  into  a  temperate  clime.  As  the  vernal  valley  of  Quito  lies  in  the 
same  latitude  as  the  destructive  coasts  of  French  Guiana,  so  the  interior  of  Af- 
rica may  possess  many  localities  gifted  with  the  same  advantages.  In  our  own 
country,  reference  has  already  been  made  to  the  marked  contrast  between  the 
Atlantic  plain  and  the  parallel  mountain  ridges;  but  it  is  in  the  geographical 
features  of  Columbia,  in  South  America,  that  we  find  most  strikingly  displayed 
the  physical  phenomenon  of  height  producing  the  effect  of  latitude — a  change  of 
climate  with  all  the  consequent  revolutions  of  animal  and  vegetable  life,  induced 
by  local  position.  It  is  on  the  mountain  slopes  of  from  3,000  to  7,000  feet, 
beyond  the  influence  of  the  noxious  miasmata,  that  man  dwells  in  perpetual 
summer  amid  the  richest  vegetable  productions  of  nature.  In  the  mountains  of 
Jamaica,  at  the  height  of  4,200  feet,  the  vegetation  of  the  tropics  gives  place  to 
that  of  temperate  regions;  and  here,  while  thousands  are  cut  off  annually  along 
the  coast  by  yellow  fever,  a  complete  exemption  exists.  In  these  elevated  re- 
gions, the  inhabitants  exhibit  the  ruddy  glow  of  health  which  tinges  the  counte- 
nance in  northern  climes,  forming  a  striking  contrast  to  the  pallid  and  sickly 
aspect  of  those  that  dwell  below.  In  ascending  a  lofty  mountain  of  the  torrid 
zone,  the  greatest  variety  in  vegetation  is  displayed.  At  its  foot,  under  the 
burning  sun,  ananas  and  plantains  flourish;  the  region  of  limes  and  oranges  suc- 
ceeds; then  follow  fields  of  maize  and  luxuriant  wheat;  and  still  higher,  the 
series  of  plants  known  in  the  temperate  zone.  The  mountains  of  temperate  re- 
gions exhibit  perhaps  less  variety,  but  the  change  is  equally  striking.  In  the 
ascent  of  the  Alps,  having  once  passed  the  vine-clad  belt,  we  traverse  in  suc- 
cession those  of  oaks,  sweet  chesnuts,  and  beeches,  till  we  gain  the  region  of 
the  more  hardy  pines  and  stunted  birches.  Beyond  the  elevation  of  6,000  feet, 
no  tree  appears.  Immense  tracts  are  then  covered  with  herbaceous  vegetation, 
the  variety  in  which  ultimately  dwindles  down  to  mosses  and  lichens,  which 
struggle  up  to  the  barrier  of  eternal  snow.  In  the  United  States  proper,  we 
have  at  least  two  summits,  the  rocky  pinnacles  of  which  shoot  up  to  the  altitude 
perhaps  of  6,500  feet.  Of  these.  Mount  Washington,  in  New  Hampshire,  is 
one.  Encircling  the  base  is  a  heavy  forest— then  succeeds  a  belt  of  stunted  firs 
— next  a  growth  of  low^  bushes— and  still  further  up  only  moss  or  lichens,  or 


no  Reviews.  [July 

lastly,  a  nnked  surface,  the  summits  of  which  are  covered,  during  ten  mortths 
of  the  year,  with  snow.  Of  the  snow-capt  peaks  of  Oregon,  we  possess  no  pre- 
cise knowledge." 

It  has,  however,  been  ascertained  that  the  decline  of  temperature  on 
rising  above  the  common  level  of  the  sea,  and  which  is  commonly  reck- 
oned at  1°  for  every  300  feet  of  elevation,  is  less  where  large  tracts  of 
country  rise  gradually  than  when  the  estimate  is  made  either  by  balloon 
ascension,  or  scaling  the  sides  of  isolated  and  precipitous  mountains.  A 
striking  illustration  of  this  is  offered  by  the  ridges  and  valleys  of  the  great 
Himmaleh  mountains  of  Southern  Asia,  where  immense  tracts,  which 
theory  would  consign  to  the  dreariness  of  perpetual  congelation,  are  found 
richly  clothed  in  vegetation  and  abounding  in  vegetable  and  animal  life. 
At  the  village  of  Zonching,  14,700  feet  above  the  level  of  the  sea,  in  lat. 
31°. 36  N.  Mr.  Colebrook  found  flocks  of  sheep  browsing  on  verdant 
hills;  and  at  the  village  of  Pui,  at  about  the  same  elevation,  there  are  pro- 
duced, according  to  Captain  Gerard,  the  most  luxuriant  crops  of  barley, 
wheat,  and  turnips,  whilst  a  little  lower  the  ground  is  covered  with  vine- 
yards, groves  of  apricots,  and  many  aromatic  plants. 

The  efiects  of  gradual  elevation  in  lessening  the  falling  ofT  of  temperature, 
is  manifested  upon  a  moderate  scale  in  our  own  country.  The  mean  tem- 
])erature  of  Eastport,  Me.,  for  example,  is  42°. 95,  whilst  that  of  Fort 
Snelling  in  the  same  latitude,  but  far  in  the  interior,  with  an  elevation  of 
some  600  or  800  feet  above  the  sea,  is  2°. 88  higher,  namely,  45°. 83,  in- 
stead of  being  two  or  three  degrees  colder,  to  correspond  with  the  law  of 
elevation. 

In  regard  to  the  extremes  of  heat  and  cold  in  the  United  States,  it  would 
be  natural  to  expect  the  greatest  heat  would  be  registered  at  the  most  south- 
erly, and  the  severest  cold  at  the  most  northern  posts.  But  the  exact  in- 
strumental observations  now  furnished,  prove  this  not  to  be  the  case, 
especially  in  the  vicinity  of  the  sea,  where  it  would  seem  the  proximity  of 
water  tends  to  moderate  the  heat  of  summer  in  the  south,  and  the  cold  of 
winter  in  the  north.  It  is  in  some  of  the  western  regions,  remote  from 
the  ocean  and  inland  seas,  those  for  example,  in  which  Forts  Siiellijig, 
Gibson,  and  Council  Bluffs,  are  situated,  that  the  mercury  rises  highest 
and  sinks  the  lowest.  On  the  I5th  of  August  1834,  at  Fort  Gibson,  two 
thermometers  observed  by  Dr.  Wright  of  the  army,  rose  in  the  shade, 
carefully  excluded  from  reflected  or  radiated  heat,  the  one  to  116°,  and  the 
other  to  117°  Fahrenheit. 

It  is  a  law  applicable  to  all  parts  of  the  world,  wherever  no  inland  lakes 
or  seas  exist,  to  interpose  a  modifying  influence, — that  on  leaving  the 
coast  and  going  into  the  interior,  the  difference  between  the  mean  tem- 
perature of  summer  and  winter  increases,  the  climates  being  more  subject 
to  extremes  of  heat  and  cold.  To  show  that  no  exception  to  this  law  is 
furnished  in  the  United  States,  we  may  adduce  the  instance  of  Fort  Sul- 
livan, Eastport,  Me.,  on  the  ocean  in  lat.  44°. 44,  where  the  winter  mean 
temperature  is  17°45  Fahrenheit  above  that  of  Fort  Snelling  in  Iowa,  the 
latitude  being  the  same.  The  climate  of  Fort  Snelling,  our  author  informs 
us,  is  the  most  excessive  among  all  the  military  posts  in  the  United  States, 
resembling  that  of  Moscow  in  Russia,  as  regards  the  extremes  of  the 
seasons,  notwithstanding  the  latter  is  11°  further  north.  But  at  Moscow 
the  mean  temperature  both  of  winter  and  summer  is  lower, — that  of 
winter   being   as  10°.78   to  15°, 95,  and   that  of  summer  as   97.°  10  to 


L.owcst 

Annual  Range. 

2° 

83° 

10° 

106° 

16° 

120° 

1842.]  Forry  on  the  Climate  of  the  United  States.  117 

72°75.  That  the  influence  of  the  lakes  in  modifying  the  climate  in  their 
vicinities  is  not  less  than  that  of  the  ocean,  is  demonstrated  by  a  com- 
parison of  the  summer  and  winter  means  of  posts  situated  near  them  in 
about  the  same  latitude.  The  difference  between  the  mean  temperature  of 
summer  and  winter  at  Fort  Preble,  on  the  Atlantic,  is  41°. 03,  and  of  Fort 
Niagara  on  Lake  Ontario,  41°. 73.  At  the  excessive  post,  Fort  Crawford, 
Wiskonsin,  a  few  minutes  further  south  than  the  two  places  first  men- 
tioned, the  difference  amounts  to  50°. 89.  Again,  a  comparison  of  the 
difference  between  the  winter  and  summer  means  of  some  other  posts 
situated  in  the  same  latitude  shows  the  following  results,  by  which  the 
increase  in  extremes  on  going  west  is  strikingly  demonstrated.  The  dif- 
ference between  the  mean  temperature  of  summer  and  winter  at  Fort 
Wolcott,  Newport,  Rhode  Island,  is  36°. 55;  at  West  Point,  N.  Y.  40°. 
75;  Fort  Armstrong,  Illinois,  49°. 05;  and  at  Council  Bluffs,  near  the 
junction  of  the  rivers  Platte  and  Missouri,  51°. 35.  The  highest,  lowest, 
and  annual  range  of  the  thermometer  at  three  of  the  posts  just  mentioned 
is  as  follows: — 

Highest 
Fort  Wolcott,  Newport,  R.  I.        85° 
Fort  Armstrong,  Illinois,  96° 

Council  Bluffs,  104° 

Although  the  mean  temperatures  of  winter  on  the  sea-coast,  is  6° 
higher,  and  of  summer,  8°. 7 1  lower  than  in  places  situated  on  the  same 
parallel  in  the  interior  beyond  the  influence  of  the  lakes,  the  means  of 
spring  are  4.°13,  and  of  autumn  0°.40,  higher  in  the  interior  situations. 
This  is  the  result  of  a  comparison  made  in  the  latitude  of  about  43°. 

How  strongly  are  all  these  views  of  the  eastern  climate  of  the  United 
States  contrasted  with  the  equable  temperature  found  in  the  Pacific  region. 
At  Fort  Vancouver,  for  example,  situated  on  the  Columbia  river,  about  75 
miles  above  its  mouth,  the  difference  between  the  winter  and  summer 
means  is  only  23°. 67,  although  a  degree  farther  north  than  Fort  Snelling, 
five  degrees  more  northerly  than  New  York,  and  nearly  on  the  same 
parallel  with  Montreal.  During  a  year  passed  at  Fort  Vancouver,  the 
lowest  fall  of  the  thermometer  was  to  17°.  On  nine  days  only  was  the 
temperature  below  the  freezing  point  in  the  month  of  January,  so  that 
ploughing  is  carried  on  whilst  the  vegetables  of  the  preceding  season  are 
still  standing  in  the  gardens  untouched  by  frost.  And  why  does  not  New 
York,  situated  directly  on  the  Atlantic  ocean,  derive  as  much  warmth  from 
this  magazine  of  heat,  as  Fort  Vancouver  does  from  the  more  distant  Paci- 
fic? Simply  because  the  predominant  westerly  winds  sweep  upon  one 
place  the  chilling  blasts  of  extensive  districts  of  land,  cooled  to  congela- 
tion, or  covered  with  snow,  whilst  over  the  other  they  waft  the  genial 
warmth  of  the  sea.  For  similar  reasons  the  ameliorations  of  climate  expe- 
rienced in  the  vicinity  of  the  interior  lakes,  must  always  be  felt  most  to 
the  eastward. 

The  classification  of  climates  distinguished  by  Dr.  Forry  in  the 
United  States  and  territories,  is  founded  upon  a  general  division  into 
Northern,  Middle  and  Southern  regions;  the  first  being  characterized  by 
the  predominance  of  a  low  mean  temperature,  the  Southern  by  a  high  tem- 
perature, and  the  Middle  vibrating  to  both  extremes.  Each  of  these 
general  divisions  is  subdivided  into  classes  or  systems  sufficiently  marked. 


118  Reviews,  \J^^Y 

The  Northern  System  has  three  classes,  ihe  first  embracing  the  coast 
of  New  England,  extending  as  far  south  as  the  harbour  of  New  York; 
the  second  including  the  districts  in  the  proximity  of  the  Northern  lakes; 
the  third,  portions  of  country  alike  remote  from  the  ocean  and  inland  seas. 

The  Middle  division  has  two  classes,  \he  first  embracing  the  Atlantic 
coast  from  Delaware  Bay  to  Savannah;  the  second,  interior  stations. 

The  Southern  division  has  also  two  classes,  the  first  including  those 
parts  in  which  the  military  posts  on  the  Lower  Mississippi  are  situated, 
and  the  second  the  peninsula  of  East  Florida. 

It  is  the  Northern  region  which  presents  at  the  same  time  the  greatest 
diversity  of  physical  character  and  the  most  strongly  marked  variations  in 
climate.  East  of  the  great  lakes  the  several  mountain  ranges  seldom  ex- 
ceed the  height  of  2500  feet  above  the  level  of  the  sea — the  table-lands 
upon  which  the  ridges  rest  rising  perhaps,  on  an  average,  to  half  the  height 
named.  We  have  already  adverted  to  the  fact,  that  on  ihe  coast  of  New 
England,  the  influence  of  the  ocean  is  manifested  in  moderating  extremes 
of  temperature.  Advancing  into  the  interior  the  extreme  range  of  the 
thermometer  increases,  and  the  seasons  are  violently  contrasted,  until  get- 
ting within  the  influence  of  the  lakes,  when  a  climate  like  that  of  the  sea- 
board is  found.  That  the  lakes  have  this  capacity  to  modify  the  climate 
in  their  vicinity  will  be  evident  to  any  one  who  considers  that  they  occupy 
not  less  than  94,000  square  miles,  having  a  depth  varying  from  20  to  500 
feet.  Beyond  the  modifying  agency  of  these  inland  seas,  temperatures 
still  more  excessive  are  exhibited,  a  comparative  view  of  which,  including 
exact  estimates  for  the  sea-coast  and  regions  of  and  beyond  the  great  lakes, 
has  been  already  given. 

When  the  climates  on  the  sea-coast  and  interior  country  remote  from  the 
lakes  are  compared  in  relation  to  the  proportions  o^  fair  and  cloudy  wea- 
ther, rain  and  snoiv,  the  following  results  appear.  During  the  year,  the 
proportion  o^  fair  days  on  the  sea-coast  compared  to  those  of  the  interior, 
are  as  202  to  240 — cloudy  days  108  to  77; — rainy  days  45  to  31;  snowy 
9  to  16. 

Comparing  the  climate  of  the  lakes  with  that  of  the  same  region  be- 
yond their  influence,  the  contrast  is  yet  more  striking,  the  prevailing  wea- 
ther of  the  former  being  cloudy,  and  the  latter  fair;  thus,  during  the  year, 
the  proportion  of  days  is. 


Fair. 

Cloudy. 

Rain. 

Snow 

Lakes,                            117 

139 

63 

45 

Remote  from  Lakes,    216 

73 

46 

29 

The  relative  proportion  of  rainy  and  cloudy  days  during  the  year  is, 
therefore,  in  the  former  locality  247,  and  in  the  latter  148,  giving  the  far 
west  about  100  more  sun-shiny  days  out  of  the  annual  sum  of  365. 

Thus  much  for  the  Northern  division. 

\\\  considering  the  climate  of  the  middle  division  of  the  United  States, 
our  author  thinks  himself  justified  by  the  results  of  the  meteorological  ob- 
servations in  his  possession,  in  distinguishing  two  classes,  designated  as 
uniform  and  excessive  climes,  the  first  being  slightly  under  the  influence 
of  the  Atlantic  Ocean,  whilst  the  southwestern  stations  show  the  powerful 
influence  of  the  Gulf  of  Mexico. 


1842."]  Forry  on  the  Climate  of  the  United  States,  119 

In  proceeding  south,  the  seasons,  as  a  general  rule,  appear  more  uni- 
form, the  annual  mean  temperature  increasing  as  a  matter  of  course.  Some 
of  the  eastern  posts  in  this  middle  division  present  such  great  contrasts  be- 
tween their  summer  and  winter  temperatures,  as  almost  to  place  them  in 
the  list  of  excessive  climes.  The  modifying  influence  of  the  adjacent 
ocean  and  bays  are  however  still  apparent,  since  farther  westward  on  the 
same  parallels,  greater  extremes  are  common. 

"  The  region  of  Pennsylvania,  as  though  it  were  the  battle  ground  on  which 
Boreas  and  Auster  struggle  for  mastery,  experiences,  indeed,  the  extremes  of 
heat  and  cold.  But  proceeding  south  along  the  Atlantic  Plain,  climate  soon 
underdoes  a  striking  modification,  of  which  the  Potomac  river  forms  the  line  of 
demarcation.  Here  the  domain  of  snow  terminates.  Beyond  this  point,  the 
sledge  is  no  more  seen  in  the  farmer's  barnyard.  The  table-lands  of  Kentucky 
and  Tennessee,  on  the  other  hand,  carry,  several  degrees  farther  south,  a  mild 
and  temperate  clime.  Although  very  few  thermometrical  observations  have 
been  made  upon  the  table-land  lying  in  the  centre  of  the  middle  division  or  upon 
the  ridges  which  crest  this  long  plateau,  thus  rendering  it  impracticable  to  de- 
termine fully  the  interesting  question  of  their  influence  upon  temperature;  yet 
we  are  enabled  to  supply  this  deficiency,  in  some  measure,  by  observations 
made  upon  the  differences  in  vegetable  geography.  Thus  in  Virginia,  as  the 
limits  of  the  state  extend  quite  across  the  Apalachian  chains,  four  natural  divi- 
sions are  presented,  viz.,  1.  The  Atlantic  Plain  or  tide-water  region,  below  the 
falls  of  the  rivers;  2.  The  Middle  region,  between  the  falls  and  the  Blue  Ridge; 
3.  The  Great  Valley,  between  the  Blue  Ridge  and  the  Alleghany  Mountains; 
and  4.  The  Trans-Alleghany  region,  west  of  that  chain.  In  each  of  these,  the 
phenomena  of  vegetation  are  modified  in  accordance  with  the  climatic  features. 
On  the  Atlantic  Plain,  tobacco  is  the  principal  staple;  in  the  Great  Valley,  it  is 
cultivated  only  in  the  southern  portion;  and  beyond  the  Alleghany,  its  culture 
is  unknown.  In  the  first  only  is  cotton  cultivated,  and  in  its  southern  part 
quite  extensively.  In  North  Carolina,  the  Atlantic  Plain  extends  60  or  70  miles 
from  the  coast,  whilst  the  Middle  region,  corresponding  to  that  described  in 
Virginia,  gradually  merges  into  the  mountainous  regions  farther  west.  As 
these  table-lands  are  elevated  from  1,000  to  1,200  feet  above  the  sea,  upon 
which  rise  many  high  crests,  one  of  which  (Black  Mountain)  is  the  highest 
summit  of  the  Alleghany  system,  the  diversity  of  climate  on  the  same  parallels 
causes  a  corresponding  difference  in  the  vegetable  productions.  Whilst  the 
low-lands  yield  cotton,  rice,  and  indigo,  the  western  high  country  produces 
wheat,  hemp,  tobacco,  and  Indian  corn.  In  South  Carolina,  three  strongly 
marked  regions  are  also  presented;  but  as  the  temperature  increases,  as  a  gene- 
ral law,  in  proportion  as  we  approach  the  equator,  cotton  is  cultivated  through- 
out the  state  generally.  Georgia,  Alabama,  and  Mississippi,  like  the  Caroli- 
nas,  are  divided  into  three  well  defined  belts,  exhibiting  similar  diversities  in 
vegetable  geography.  Cotton  and  rice,  more  especially  the  former,  are  the 
great  agricultural  staples;  and  on  the  Atlantic  Plain  of  these  three  states,  as 
well  as  its  continuation  into  Florida  and  Louisiana,  (which  last  two  will  be 
more  particularly  adverted  to  in  the  southern  division,)  sugar  may  be  advan- 
tageously cultivated.  In  North  Carolina  and  Virginia,  the  Atlantic  Plain 
forms,  as  it  were,  a  chaos  of  land  and  water,  consisting  of  vast  swamps,  traversed 
by  sluggish  streams,  expanding  frequently  into  broad  basins  with  argillaceous 
bottoms.  Throughout  its  whole  extent,  as  already  remarked,  it  is  characterized 
by  similar  features,  besides  being  furrowed  with  deep  ravines  in  which  the 
streams  wind  their  devious  way.  The  hot  and  sultry  atmosphere  of  these  low- 
lands, in  which  malarial  diseases  in  every  form  are  dominant,  contrasts  strongly 
with  the  mild  and  salubrious  climate  of  the  mountain  regions— results  that  will 
be  developed  more  fully  in  the  investigation  of  endemic  influences. 

"  It  may  not  be  amiss,  as  illustrative  of  the  comparative  temperature  of  the  At- 
lantic Plain  and  the  adjacent  mountain  region,  to  present  here  a  few  thermorae- 


120 


Reviews. 


[July 


trical   data,  however  limited  in  extent,  noted,  during  the  summers  of  1839  and 
1840  at  Flat  Rock,  Buncombe  county.  North  Carolina. 


Places  of  Observation. 

Lat. 

Me;<n  Temperature. 

July.     1     Aug.    1    Sept.    |     Oct. 

Fort  Monroe,  Coast  of  Virginia, 
Flat  Rock,  Buncombe,  N.  C, 
Charleston,  South  C;irolina, 

370.00 
350.30 

320.45 

8O0 
690 
8I0 

700 
700 

8I0 

720 
62° 

770 

64° 
61° 
71° 

"  Flat  Rock  is  about250  miles  from  the  Atlantic,  and  is  elevated  perhaps  2,500 
feet  above  the  level  of  the  ocean,  whilst  the  latitude  given  is  also  a  mere  approxi- 
mation derived  from  general  knowledge.  The  observations  made  at  Charleston 
embrace  the  same  years  as  those  at  Flat  Rock,  but  the  data  at  Fort  Monroe  com- 
prise the  years  1828,  29,  and  30.  It  is  thus  seen  that  the  difference  of  tempera- 
ture at  Flat  Rock  and  the  other  two  points,  taking  an  average  of  the  latter,  is  in 
July  11°,  August  10°,  September  13°,  and  October  6°.  As  regards  the  monthly 
range  of  the  thermometer,  little  difference  is  presented." 

Although  the  general  inquirer  may  find  most  interest  in  considering  the 
phenomena  connected  with  climatology  in  the  two  first  general  divisions  of 
the  United  States,  the  medical  inquirer  will  attach  the  most  importance  to 
the  characteristics  of  the  southern  region,  as  this  presents  the  most  for- 
midable array  of  diseases,  and  at  the  same  time  holds  out  a  refuge  to  vale- 
tudinarians who  could  not  long  resist  the  combined  pressure  of  disease 
and  a  rigorous  northern  winter  clime. 

Along  the  Atlantic  coast  of  the  United  States,  the  mean  temperature  of 
the  year  diminishes  in  a  very  unequal  ratio.  Between  Charleston  and 
Philadelphia,  the  difference  of  means  is  10^°  Fahr.,  or  in  the  proportion  of 
about  1^°  of  temperature  to  1°  of  latitude.  Between  Philadelphia  and 
Eastport,  Maine,  the  difference  in  means  is  much  greater,  namely,  12°. 33 
Fahr.  being  in  the  increased  proportion  of  nearly  2°. 5  of  mean  tempera- 
ture per  degree  of  latitude.  Again,  between  Charleston,  S.  C,  and  New 
York  harbour,  the  difference  of  means  is  12°. 78,  or  1°.59  per  degree  of 
latitude.  Between  New  York  harbour  and  Eastport,  Maine,  the  differ- 
ence is  11°,  or  about  2|°  Fahr.  per  degree  of  latitude.  The  average  pro- 
portion between  Charleston,  S.  C.,  and  Eastport,  Maine,  is  equal  to  about 
2°  of  temperature  for  each  degree  of  latitude. 

In  approaching  south,  the  extremes  of  winter  and  summer  grow  less, 
and  the  seasons  glide  more  imperceptibly  into' each  other.  At  Fort  Snel- 
ling,  situated  in  the  excessive  climate  of  the  west,  in  latitude  44°. 53,  the 
difference  between  the  summer  and  winter  means  is,  as  has  been  before 
stated,  no  less  than  56°. 60;  at  Eastport,  Maine,  39°. 15,  at  West  Point, 
N.  Y.,  40°.75,  at  Charleston,  S.  C,  30°. 34,  at  St.  Augustine,  Florida, 
20°,  whilst  at  Key  West,  it  is  only  11°. 34. 

"There  is,"  says  Dr.  Forry,  "little  difference  between  the  thermometrical 
phenomena  presented  at  Key  West  and  the  Havana.  In  the  West  India  islands, 
the  mean  annual  temperature  near  the  sea  is  only  about  80°.  At  Barbadoes,  the 
mean  temperature  of  the  seasons  is — winter,  76°,  spring  79°,  summer  81°,  and 
autumn  80°.  The  temperature  is  remarkably  uniform;  for  the  mean  annual 
range  of  the  thermometer,  even  in  the  most  excessive  of  the  islands,  is  only  13°, 
and  in  some  it  is  not  more  than  4°.*  Contrast  this  with  Hancock  Barracks, 
Maine,  which  gives  an  average  annual  range  of  118°,  Fort  Snelling,  Iowa,  119°, 
and  Fort  Howard,  Wiskonsin,  123°! 

"The  peculiar  character  of  the  climate  of  East  Florida,  as  distinguished  from 

*  According  to  the  British  Army  Statistics. 


1842.]  Forry  on  the  Climate  of  the  United  States.  121 

that  of  our  more  northern  latitudes,  consists  less  in  the  mean  annual  tempera- 
ture than  in  the  manner  of  its  distribution  among  the  seasons.  At  Fort  Snel- 
ling-,  for  example,  the  mean  temperature  of  winter  is  15°. 95,  and  of  summer 
72°. 75,  whilst  at  Fort  Brooke,  Tampa  Bay,  the  former  is  64°. 76,  and  the  latter 
84°.25,  and  at  Key  West,  70°.05,  and  81°.39.  Thus  though  the  winter  at  Fort 
Smelling  is  54*^.10  colder  than  at  Key  West,  yet  the  mean  temperature  of  sum- 
mer at  the  latter  is  only  8°. 64  higher.  In  like  manner,  although  the  mean 
annual  temperature  of  Petite  Coquille,  Louisiana,  is  nearly  2°  lower,  that  of 
Augusta  Arsenal,  Georgia,  nearly  8°,  and  that  of  Fort  Gibson,  Arkansas,  up- 
wards of  10°  lower  than  that  of  Fort  Brooke;  yet  at  all,  the  mean  summer  tem- 
perature is  higher.  Between  Fort  Snelling  on  the  one  hand,  and  Fort  Brooke 
and  Key  West  on  the  other,  the  relative  distribution  of  temperature  stands  thus: 
Difference  between  the  mean  temperature  of  summer  and  winter  at  the  former 
56°. 60,  and  at  the  two  latter  16°. 49  and  11°. 34;  difference  between  the  mean 
temperature  of  the  warmest  and  coldest  month,  61°. 86  compared  with  18°. 66 
and  14°. 66;  difference  between  the  mean  temperature  of  winter  and  spring, 
30°.83  to  8^.35  and  5°.99;  and  the  mean  difference  of  successive  months,  10°.29 
to  3°.09  and  2°. 44." 

A  comparison  in  regard  to  equality  and  mildness  of  climate  drawn  be- 
tween the  seasons  of  Florida  and  those  of  the  most  favoured  places  on  the 
European  continent,  those  of  Italy  and  southern  France,  results  generally 
in  favour  of  the  Florida  Peninsula.  At  Key  West  the  annual  range  of  the 
thermometer  is  but  37^.  The  advantages  East  Florida  presents  to  invalids 
as  a  winter  residence,  are  therefore  very  obvious. 

The  question  has  been  much  debated,  whether  the  temperature  of  the 
crust  of  the  earth  or  of  the  incumbent  atmosphere  has  undergone  any  per- 
ceptible changes  since  the  earliest  records,  either  from  the  efforts  of  man 
in  clearing  away  forests,  draining  marshes,  cultivating  the  ground,  or  other 
causes.  La  Place  has  demonstrated  very  satisfactorily,  that  since  the  days 
of  Hipparcus,  an  astronomer  of  the  Alexandrian  school,  who  flourished 
about  2000  years  ago,  the  earth  cannot  have  become  a  single  degree  of 
heat  warmer  or  colder,  as  otherwise  the  sidereal  day  must  have  become 
either  lengthened  or  shortened,  which  is  not  the  case. 

As  to  the  question  of  changes  in  atmospheric  temperature  affecting 
the  seasons,  M.  Arago  thinks  that  sufficient  proofs  exist  to  justify  the  con- 
clusion that  in  Europe,  at  least,  a  sensible  elevation  of  the  annual  mean 
temperature  has  resulted  from  the  conquests  of  agriculture.  The  thermo- 
meter is  comparatively  a  modern  instrument,  invented  by  Galileo  in  1590, 
but  still  left  so  imperfect,  that  it  was  not  till  1700  that  Fahrenheit  suc- 
ceeded in  improving  and  rendering  it  a  correct  and  perfect  instrument.  It 
is  evident  that  the  want  of  exact  instrumental  observations  prior  to  the 
commencement  of  agricultural  improvements  must  render  it  extremely  dif- 
ficult to  determine  with  any  precision,  what  changes  may  have  been  ef- 
fected through  these  in  the  mean  temperatures  of  the  year  or  particular 
seasons.  Hence,  notwithstanding  the  expression  of  his  belief  in  the 
changes  of  atmospheric  temperature,  M.  Arago  looks  to  America  for  the 
necessary  data  by  which  the  point  must  be  definitely  settled. 

"Ancient  France,"  he  remarks,  "contrasted  with  what  France  now  is,  pre- 
sented an  incomparably  greater  extent  of  forests;  mountains  almost  entirely 
covered  with  wood,  lakes  and  ponds,  and  morasses,  without  number;  rivers 
without  any  artificial  embankment  to  prevent  their  overflow,  and  immense  dis- 
tricts, which  the  hands  of  the  husbandman  had  never  touched.  Accordingly, 
the  clearing  away  of  the  vast  forests,  and  the  opening  of  extensive  glades  in 
No.  VII.— July,  1842.  11 


122  Reviews.  [July 

those  that  remain;  the  nearly  complete  removal  of  all  stagnant  waters,  and  the 
cultivation  of  extensive  plains,  which  thus  are  made  to  resemble  the  stepes  of 
Asia  and  America — these  are  among  the  principal  modifications  to  which  the 
fair  face  of  France  has  been  subjected,  in  an  interval  of  some  hundreds  of  years. 
But  there  is  another  country  which  is  undergoing  these  same  modifications  at 
the  present  day.  They  are  there  progressing  under  the  observation  of  an  en- 
lightened population;  they  are  advancing  with  astonishing  rapidity;  and  they 
ought,  in  some  degree,  suddenly  to  produce  the  meteorological  alterations  which 
many  ages  have  scarcely  rendered  apparent  in  our  old  continent.  This  country 
is  North  America.  Let  us  see,  then,  how  clearing  the  country  affects  the  cli- 
mate there.  The  results  may  evidently  be  applied  to  the  ancient  condition  of 
our  own  countries,  and  we  shall  find  that  we  may  thus  dispense  with  a  priori 
considerations,  which,  in  a  subject  so  complicated,  would  probably  have  mis- 
led us." 

There  is  great  force  in  the  following  remarks  of  Dr.  Forry,  and  the 
facts  adduced  in  their  support: 

"  Dense  forests  and  all  growing  vegetables  doubtless  tend  considerably  to 
diminish  the  temperature  of  summer,  by  affording  evaporation  from  the  surface 
of  their  leaves,  and  preventing  the  calorific  rays  from  reaching  the  ground.  It 
is  a  fact  equally  well  known  that  snow  lies  longer  in  forests  than  on  plains,  be- 
cause, in  the  former  locality,  it  is  less  exposed  to  the  action  of  the  sun;  and 
hence,  the  winters,  in  former  years,  may  have  been  longer  and  more  uniform. 
As  the  clearing  away  of  the  forest,  causes  the  waters  to  evaporate  and  the  soil 
to  become  dry,  some  increase  in  the  mean  summer  temperature,  diametrically 
contrary  to  the  opinion  of  Jefferson  and  others,  necessarily  follows.  It  is  re- 
marked by  Umfreville  that,  at  Hudson's  Bay,  the  ground  in  open  places  thaws 
to  the  depth  of  four  feet,  and  in  the  woods  to  the  depth  only  of  two.  More- 
over, it  has  been  determined  by  thermometrical  experiments  that  the  tempera- 
ture of  the  forest,  at  the  depth  of  twelve  inches  below  the  surface  of  the  earth, 
is,  compared  with  an  adjacent  open  field,  at  least  10°  lower,  during  the  summer 
months;  whilst  no  difference  is  observable  during  the  season  of  winter. 

"It  may,  therefore,  be  assumed,  that  although  cultivation  of  the  soil  may  not 
be  productive  of  a  sensible  change  in  the  mean  annual  temperature,  yet  such  a 
modification  in  the  distribution  of  heat  among  the  seasons  may  be  induced  as 
will  greatly  influence  vegetation." 

Bearing  upon  this  point.  Dr.  Forry  furnishes  a  table  exhibiting  a  compa- 
rative view  of  the  atmospheric  temperature  at  Philadelphia,  at  intervals  of 
about  a  quarter  of  a  century,  (from  1771  to  1824,)  which  shows  a  succes- 
sive decrease  in  the  mean  of  winter,  and  an  increase  in  the  means  of 
spring,  summer,  autumn,  and  whole  year.*  Some  allowance  must  be 
made  in  these  estimates  for  the  effects  of  increase  in  the  size  of  the  city, 
and  the  additional  shelter  in  winter,  and  opportunity  of  accumulating  heat 
in  summer  thus  afforded.  All  towns  are  observed  to  grow  warmer  as  they 
extend  their  limits.  When,  therefore,  we  fiind  a  decline  in  the  mean  tem- 
perature of  winter,  notwithstanding  the  extension  of  the  city  limits,  we 
must  infer  that  it  can  arise  from  no  other  cause  than  a  general  diminution 
in  the  winter  temperature  throughout  the  country. 

Any  changes  in  the  climate  of  the  United  States  as  yet  perceived,  are 
very  far  from  justifying  the  sanguine  calculations  indulged  in  a  few  years 

*  The  6th  volume  of  Transactions  of  the  American  Philosophical  Society,  new 
series,  contains  an  abstract  of  meteorological  tables,  showing  the  temperature  at  Phi- 
ladelphia  for  80  years  from  1758  to  1833,  giving  the  mean  of  each  month,  the  annual 
mean;  and  the  greatest  and  least  degrees  of  heat;  the  last  part  of  the  series,  embracing 
the  period  from  1829  to  1838,  by  Dr.  Thomas  T.  Hewson. 


1842.]  Kighy's  System  of  Midwifery,  123 

ago  by  a  writer  on  the  climate  and  vegetation   of  the  fortieth  degree  of 
North  latitude,*  who,  in  concluding  his  essay,  says: 

"But  there  will  doubtless  be  an  amelioration  in  this  particular,"  (seve- 
rity of  cold)  "  when  Canada  and  the  United  States  shall  become  thickly 
peopled  and  generally  cultivated.  In  this  latitude,  then,  like  the  same 
parallels  in  Europe  at  present,  S7io?v  and  ice  ivill  become  rare  phenomena, 
and  the  orange,  the  olive,  and  other  vegetables  of  the  same  class,  now 
strangers  to  the  soil,  ivill  become  objects  of  the  labour  and  solicitude  of 
the  agriculturist^ 

Had  this  writer  extended  his  inquiries  a  little  further,  he  might  have 
found  that  the  region  of  Oregon,  lying  west  of  the  Rocky  Mountains, 
though  as  yet  in  a  primitive  state  of  nature,  has  a  climate  even  milder  than 
that  of  highly  cultivated  Europe  in  similar  latitudes.  And  again,  China, 
situated  precisely  under  the  same  conditions  as  the  United  States  in  regard 
to  the  sea,  though  long  since  subjected  to  the  highest  state  of  agricultural 
improvement,  possesses  a  winter  climate  as  rigorous,  and  some  assert 
even  more  so,  than  that  of  the  United  States  in  similar  latitudes. 

There  are  many  points  considered  by  our  author  which  it  would  have 
given  us  pleasure  to  have  noticed  more  particularly.  We  have  endeavoured 
to  follow  him  through  the  main  course  of  his  investigation,  and  when  it  is 
considered  that  the  facts  and  views  he  presents  are  original,  and  the  results 
of  years  of  observation  and  severe  mental  toil,  upon  subjects  essentially 
connected  with  medical  inquiries,  we  hope  we  shall  not  be  considered  as 
having  gone  out  of  the  track  of  our  professional  readers,  or  trespassed  too 
much  upon  their  valuable  time. 

G.  E. 


Art.  XII. — A  System  of  Midwifery,  ivith  numerous  wood  cuts.  By 
Edward  Rigby,  M.  D.,  &:c.,  with  Notes  and  additional  illustrations. 
Philadelphia,  Lea  &  Blanchard,  1841:  8vo.  pp.  491. 

We  know  of  no  series  of  treatises,  devoted  to  a  consideration  of  the  dif- 
ferent branches  of  medical  science,  the  character  of  which  has  been  so 
uniformly  sustained  as  that  which  composes  the  several  volumes  of  Twee- 
die's  Library  of  Medicine.  If  the  successive  portions  of  the  work  do  not 
actually  exceed  in  value  those  which  preceded,  they,  at  least,  in  no  in- 
stance sink  below  them; — while  the  whole,  so  far  as  published,  presents  a 
very  able,  and  generally  speaking,  full  and  accurate  exposition  of  the  actual 
condition  of  the  healing  art,  as  well  in  relation  to  its  principles  as  to  its 
practical  details. 

The  volume  before  us,  which  embraces  the  obstetrical  department  of 
the  Library,  will  command  a  high  rank  among  the  numerous  systems  of 
midwifery  that  have  appeared  within  the  few  past  years,  bearing  the  names 
of  some  of  the  most  distinguished  cultivators  of  the  obstetric  art. 

While  the  author  has  made  free  use  of  the  labours  of  his  predecessors 
and  contemporaries,  he  has  not  confined  himself  to  the  humble  task  of  a 

*  Remarks  on  the  Climate  and  Vegetation  of  the  fortieth  degree  of  North  latitude. 
By  Richard  Sexton,  M.  D.,  published  in  the  5th  volume  of  this  Journal;  a  paper  con- 
taining  many  highly  interesting  observations  upon  the  Climatology  of  the  United 
States. 


124  Reviews,  [July 

mere  compiler,  but  has  skilfully  woven  into  a  continuous  narrative  those 
principles  and  rules  of  practice  in  the  department  of  which  he  treats,  that 
have  become  the  common  property  of  the  profession,  giving,  at  the  same 
time,  to  the  facts  and  directions  he  details  a  sanction  and  authority  derived 
from  his  own  personal  experience  and  observation. 

The  great  object  at  which  Dr.  Rigby  appears  to  have  aimed,  is  perfect 
accuracy,  with  as  great  a  degree  of  conciseness  as  was  compatible  with  a 
clear  exposition  of  every  important  point  connected  with  his  subject;  and 
in  the  attainment  of  this,  he  has  been  enabled  to  present  to  the  profession 
a  work,  equally  valuable  as  a  manual  for  the  use  of  the  obstetrical  student, 
and  a  compendium  of  the  experience  of  the  whole  profession  by  which 
the  practitioner  may  compare  and  correct  the  results  of  his  own  observa- 
tions. 

Notwithstanding  the  term  Midwifery  strictly  speaking  implies  only  the 
proper  management  of  the  process  of  parturition,  Dr.  Rigby  extends  it, 
in  common  with  the  major  portion  of  modern  writers,  to  "  the  knowledge 
and  art  of  treating  a  woman  and  her  child  during  her  pregnancy,  labour, 
and  the  puerperal  state." 

The  work  commences  with  a  short  anatomico-physiological  view  of  the 
structure,  form,  arrangement  and  functions  of  those  parts  and  organs 
which  are  more  or  less  directly  concerned  in  the  important  processes  of 
pregnancy  and  parturition.  Then  follow  in  succession  the  diagnosis  and 
course  of  healthy  pregnancy,  and  its  various  diseases,  terminating  with  the 
subject  of  healthy  parturition,  and  its  treatment;  parturition  properly 
speaking  comes  under  two  separate  heads,  eutocia  and  dystocia,  the  one 
signifying  natural  or  favourable  labour,  the  other  unnatural,  faulty  or  un- 
favourable labour;  and  lastly,  a  short  account  is  presented  of  some  of  the 
more  important  diseases  which  occur  to  the  mother  during  the  first  month 
after  parturition. 

The  first  part,  as  is  stated  above,  treats  of  the  anatomy  and  physiology 
of  utero-gestation,  embracing  a  very  accurate  and  intelligible  description  of 
the  structure,  axes  and  diameters  of  the  female  pelvis,  the  anatomy  of  the 
female  organs  of  generation,  the  phenomena  consequent  upon  impregna- 
tion, and  the  history  and  development  of  the  ovum. 

Without  entering  into  a  consideration  of  the  various  speculations  that 
have  been  advanced  by  distinguished  writers,  in  relation  to  the  physiology 
of  utero-gestation,  the  author  presents  a  clear,  concise,  and  instructive  view 
of  every  well  established  fact  connected  with  this  interesting  and  important 
subject. 

In  regard  to  the  corpora  lutea,  in  relation  to  which  some  misconception 
would  appear  still  to  exist,  the  following  remarks  of  Dr.  Rigby  may  not 
be  without  instruction  to  the  few  who  continue  to  doubt  their  dependence 
upon  successful  impregnation. 

*'  A  Graafian  vesicle  cannot  be  converted  into  a  corpus  luteum  except  by  ac- 
tual and  effective  sexual  intercourse;  and  the  strange  and  discrepant  accounts 
which  have  every  now  and  then  been  published,  even  by  authors  of  consider- 
able repute,  of  corpora  lutea  having  been  found  in  the  ovaries  of  virgin  and 
even  new^ly  born  animals,  merely  prove  that  the  true  characteristics  of  the  corpus 
luteum  were  not  sufficiently  known.  The  irregular  cysts,  cavities  or  deposites 
of  whitish  or  yellowish  structure  which  are  frequently  found  in  the  ovary,  inde- 
pendent of  impregnation,  and  which  have  been  improperly  enough  called  virgin 
corpora  lutea,  present  points  of  difference  so  marked,  that  they  can  scarcely  be 
mistaken  by  an  experienced  eye.     The  angular  cavity  opening  externally,  the 


1842.]  "Righy's  System  of  Midwifery.  125 

stellated,  radiated,  cicatrix-like  appearance,  which  a  section  of  the  corpus  lu- 
teum  presents,  its  soft  and  delicate  structure  as  described  by  Dr.  Hunter,  and, 
above  all,  its  vascularity,  and  the  facility  with  which  its  vessels  can  be  injected 
from  the  general  tissue  of  the  ovary,  are  characters  only  found  in  a  true  corpus 
luteum.  Virgin  corpora  lutea  frequently  occur  under  circumstances  of  disease, 
especially  those  of  a  tubercular  character.  They  frequently  appear  as  distinct 
cysts,  the  walls  of  vi^hich  are  semi-cartilaginous;  at  other  times,  they  seem  to  be 
nothing  more  than  a  coagulum  of  blood:  they  seldom  project  much  from  the 
ovary,  and  in  no  instance  have  they  the  peculiar  structure  of  the  corpus  luteum, 
nor  the  external  cicatrix,  nor  are  they  capable  of  being  injected." 

"  When  pregnancy  is  over,  the  corpus  luteum  gradually  diminishes  and  disap- 
pears. Dr.  Montgomery  states  that,  'the  exact  period  of  its  tQtal  disappearance 
I  am  unable  to  state,  but  I  have  found  it  distinctly  visible  so  late  as  at  the  end 
of  five  months  after  delivery  at  the  full  time,  but  not  beyond  this  period.' 
Hence  it  will  be  seen,  that  in  a  few  months  after  the  termination  of  pregnancy, 
all  traces  of  the  corpus  luteum  are  lost,  and  that,  therefore,  it  will  be  impossible 
to  decide  as  to  how  frequently  impregnation  has  taken  place,  merely  by  exam- 
ining the  ovaries  as  has  been  supposed.  There  is  another  point  to  which  Dr. 
Montgomery  has  alluded,  which  is  well  worthy  of  notice:  in  mentioning  the 
fact,  that  a  vesicle  may  contain  two  ova,  and  thus  a  woman  be  delivered  of  twins, 
and  yet  there  be  but  one  corpus  luteum,  he  observes,  that  '  the  presence  of  a  cor- 
pus luteum  does  not  prove  that  a  woman  has  borne  a  child,  although  it  would  be 
a  decided  proof  that  she  had  been  impregnated,  and  had  conceived,  because,  it 
is  quite  obvious  that  the  ovum  after  its  vivification  may  be,  from  a  great  variety 
of  causes,  blighted  and  destroyed,  long  before  the  fcEtus  has  acquired  any  distinct 
form.  It  may  have  been  converted  into  a  mole  or  hydatids:  thus,  however  para- 
doxical it  may  at  first  sight  appear,  it  is  nevertheless  true,  that  a  woman  may 
conceive  and  yet  not  become  truly  with  child,  a  fact  already  alluded  to,  as  no- 
ticed by  Harve)';  but  the  converse  will  not  hold  good.  I  believe  no  one  ever 
found  a  foetus  in  utero  without  a  corpus  luteum  in  the  ovary;  and  that  the  truth 
of  Haller's  corollary,  '  nullus  unquam  conceptus  est  absque  corpore  luteo,'  re- 
mains undisputed.'  " 

The  second  part  of  the  work  treats  of  natural  pregnancy  and  its  devia- 
tions. The  chapter  on  the  signs  of  pregnancy  exhibits  much  good  sense, 
commendable  caution,  and  sound  discrimination. 

The  difficulty,  and  at  the  same  time,  the  great  importance,  in  many 
cases,  of  arriving  at  a  correct  diagnosis  of  pregnancy  are  clearly  and  fully 
stated;  while  each  of  the  phenomena  consequent  upon  utero-gestation,  as 
well  the  general  effects  it  produces  upon  the  system,  as  those  changes  and 
phenomena  which  are  peculiar  to  this  state,  are  individually  described,  and 
the  absolute  and  relative  importance  of  each  carefully  examined.  The 
entire  chapter  is  one  of  great  merit. 

After  showing  the  insufficiency  of  the  major  portion  of  those  phenomena 
usually  esteemed  as  indicative  of  pregnancy,  the  author  remarks, 

"  In  reviewing  what  has  now  been  stated  respecting  the  diagnosis  of  preg- 
nancy, it  will  be  observed,  that  we  have  enumerated  four  symptoms,  which 
must  be  looked  upon  as  perfectly  diagnostic  of  this  condition,  and  in  the  accu- 
racy and  certainty  of  which  we  may  place  the  fullest  confidence:  two  may  be 
recognised  at  an  early  period  by  means  of  auscultation,  viz.  the  sounds  produced 
by  the  movements  of  the  foetus,  and  by  the  pulsations  of  its  heart;  the  two  others 
are  not  appreciable  until  a  later  period,  and  are  afforded  by  manual  examination, 
viz.  the  being  able  to  feel  the  head  of  the  foetus,  per  vaginam,  and  its  move- 
ments through  the  abdominal  parietes.  The  next  in  point  of  value  after  these 
are  the  changes  in  the  os  and  cervix  uteri,  those  connected  with  the  formation  of 
the  areola  in  the  breasts,  and,  at  a  somewhat  later  period,  the  sound  of  the  ute- 
rine circulation;  changes  which,  although  they  cannot  separately  be  entirely  de- 
ll* 


126  Revietas.  [.■^^^Y 

pended  upon,  are  nevertheless  symptoms  of  very  great  importance  in  the  diagno- 
sis of  pregnancy." 

"Two  other  signs  of  pregnancy  have  also  been  mentioned,  viz.,  the  appear- 
ance of  a  peculiar  deposite  in  the  urine  as  described  by  M.  Nauche,  or  rather 
by  Savonarola,  (Montgomery,  Op.  Cit.^  p.  157,)  and  the  purple  or  violet  appear- 
ance of  the  mucous  membrane  lining  the  vagina,  and  os  externum,  as  described 
by  Professor  Kluge  of  the  Charite  at  Berlin,  and  by  MM.  Jacquemin,  Parent  Du- 
chatelet,  &c.  of  Paris.  With  regard  to  the  first,  which  is  an  old  popular  symp- 
tom of  pregnancy,  there  is  too  much  variety  in  the  appearances  of  the  urine, 
depending  on  general  health,  diet,  temperature,  &c.,  to  enable  us  to  place  much 
confidence  in  any  change  of  this  sort." 

"The  purple  colour  of  the  vaginal  entrance  appears,  from  the  extensive  expe- 
rience of  the  above-mentioned  authors,  to  be  a  pretty  constant  change  produced 
by  the  state  of  pregnancy;  it  probably  occurs  at  a  very  early  period.  How  far 
a  similar  tinge  is  produced  by  the  state  of  uterine  congestion  immediately  before 
a  menstrual  period,  we  are  unable  to  say;  at  any  rate,  the  character  of  the  exa- 
mination itself  must  ever  be  sufficient  to  preclude  its  being  practised  in  this 
country." 

The  ensuing  chapter  on  the  treatment  of  pregnancy,  presents  a  concise, 
but  judicious  view  of  the  remedies  adapted  to  the  removal  of  those  dis- 
turbances of  function  and  other  affections  so  often  consequent  upon  utero- 
gestation — and  which,  though  in  the  ordinary  run  of  cases  they  are  very 
readily  subdued,  occasionally  cause  great  distress  to  the  patient,  and  in 
their  management,  demand  no  little  skill  and  caution  on  the  part  of  the 
practitioner. 

The  signs  of  the  death  of  the  foetus  are  next  considered,  and  a  very 
lucid  and  able  exposition  is  given  of  the  phenomena  resulting  from  the 
cessation  of  life  in  the  child,  as  they  occur  before  and  during  labour,  with 
their  individual  and  collective  value.    As  Dr.  Rigby  very  justly  remarks — 

"There  are  few  circumstances  more  painful  to  the  feelings  of  an  accoucheur, 
than  the  uncertainty  as  to  whether  the  child  be  alive  or  dead,  in  a  labour  where 
the  passage  of  the  head  is  rendered  unusually  difficult  or  dangerous  for  the  mo- 
ther, even  with  the  aid  of  the  forceps;  whether  the  difficulty  be  produced  by 
want  of  proportion  between  the  head  and  pelvis,  unusual  rigidity  of  the  os  uteri, 
&c.  Could  he  assure  himself  that  it  was  alive,  he  would  feel  justified  in  either 
trusting  still  longer  to  the  efforts  of  nature,  or  in  applying  the  forceps,  even 
although  he  knows  that  the  delivery  cannot  be  effected  without  considerable  dif- 
ficulty and  suffering:  whereas,  if  he  could  once  feel  satisfied  that  the  child  had 
ceased  to  exist,  he  would  have  recourse  to  perforation,  for  the  purpose  of  dimi- 
nishing the  size  of  the  head,  and  thus  releasing  the  mother  from  the  dangers  of 
her  situation." 

The  following  paragraph  proposes  an  important  consideration,  which 
should  be  duly  weighed  by  every  practitioner  of  midwifery. 

"The  increasing  success  which  has  attended  the  Cassarean  operation  of  late 
years,  adds  still  more  to  the  importance  of  having  the  signs  of  the  child's  life  or 
death  in  utero  carefully  investigated  and  understood;  for  under  such  circum- 
stances, it  becomes  a  most  serious  question  whether  we  are  justified  in  destroy- 
ing the  life  of  the  foetus  by  perforation,  when  we  might  in  all  probability  have 
saved  it  by  resorting  to  another  means  of  delivery,  which,  formidable  as  it  is,  is 
now  infinitely  less  so  than  it  was  in  former  times.  It  becomes  a  question  whe- 
ther we  ought  not,  in  certain  cases,  to  adopt  the  same  indications  for  performing 
the  Cassarean  operation,  as  are  used  upon  the  continent,  and  apply  it  not  only  to 
those  cases  where  the  child  cannot  be  delivered  per  vias  naturaies,  but  also  to 
those  cases  of  minor  pelvic  obstruction,  where,  if  we  could  feel  sure  of  the 
child's  death,  we  should  have  recourse  to  perforation.     Under  circumstances  of 


A 


1842.]  Rigby's  System  of  Midwifery,  127 

this  nature,  the  question  becomes  one  of  fearful  responsibility,  the  painfulness 
of  which  is  not  a  little  increased  by  the  uncertainty  as  to  whether  the  child  be 
alive  or  not." 

The  chapters  on  mole  pregnancy,  extra-uterine  pregnancy,  and  retro- 
versing  of  the  uterus,  present  a  very  comprehensive  and  admirable  expo- 
sition of  the  actual  state  of  our  knowledge  in  relation  to  the  causes,  diag- 
nostic symptoms  and  proper  management  of  these  cases.  It  would  be 
difficult  to  refer  to  any  work  in  which  will  be  found  a  more  accurate  and, 
at  the  same  time,  so  clear  and  definite  an  account  of  either  of  the  foregoing 
subjects,  more  especially  one  presented  in  so  condensed  a  form  as  that  in 
the  volume  before  us. 

The  duration  of  pregnancy  is  the  subject  of  chapter  seven.  The  grand 
question  which  this  subject  involves,  whether,  namely,  a  female  can  really 
go  beyond  the  common  period  of  gestation,  receives  that  attention  from 
the  author  which  its  importance  merits.  After  pointing  out  the  ordinary 
sources  of  error  in  computing  the  duration  of  pregnancy,  especially  the 
assumption  of  various  and  uncertain  data  by  which  to  determine  the  mo- 
ment of  conception,  Dr.  Rigby,  from  various  considerations,  concludes  that 
the  period  of  forty  weeks,  or  ten  lunar  months,  is  most  generally  that  of 
gestation  in  the  human  female;  although  for  certain  reasons  connected  with 
his  view  of  the  causes  which  determine  the  period  at  which  labour  usually 
comes  on,  he  is  inclined  to  believe  it  may  occasionally  fall  short  or  exceed 
somewhat  this  period. 

"It  is  now,"  he  remarks,  "ten  years  ago  since  we  first  surmised,  that  *the 
reason  why  labour  usually  terminates  pregnancy  at  the  fortieth  week,  is  from 
the  recurrence  of  a  menstrual  period  at  a  time  during  pregnancy,  when  the  ute- 
rus, from  its  distension  and  Aveight  of  contents,  is  no  longer  able  to  bear  that 
increase  of  irritability  which  accompanies  these  periods  without  being  excited 
to  throw  off  the  ovum.' 

"  Under  the  head  of  premature  expulsion,  we  shall  have  occasion  to  notice 
the  disposition  to  abortion,  which  the  uterus  evinces  at  what,  in  the  unimpreg- 
nated  state,  would  have  been  a  menstrual  period:  for  some  months  after  the  com- 
mencement of  pregnancy,  a  careful  observer  may  distinctly  trace  the  periodical 
symptoms  of  uterine  excitement  corning  on  at  certain  intervals,  and  it  may  be 
easily  supposed  that  many  causes  for  abortion  act  with  increased  effect  at  these 
times.  Where  the  patient  has  suffered  from  dysmenorrhoea  before  pregnancy, 
these  periods  continue  to  be  marked  with  such  an  increase  of  uterine  irritability 
as  to  render  them  for  some  time  exceedingly  dangerous  to  the  safety  of  the  ovum. 
Even  to  a  late  period  of  gestation,  the  uterus  continues  to  indicate  a  slight  in- 
crease of  irritability  at  these  periods,  although  much  more  indistinctly;  thus,  in 
cases  of  hemorrhage  before  labour,  especially  where  it  arises  from  the  attach- 
ment of  the  placenta  to  the  os  uteri,  it  is  usually  observed  to  come  on,  and  to 
return  at  what,  in  the  unimpregnated  state,  would  have  been  a  menstrual  period. 
We  mention  these  facts  as  illustrating  what  we  presume  are  the  laws  on  which 
the  duration  of  pregnancy  depends,  and  also  as  being  capable  of  affording  a  satis- 
factory explanation  of  those  seeming  over-term  cases,  which  are  occasionally 
met  with. 

"From  this  view  of  the  subject  it  will  be  evident,  that  the  period  of  the  men- 
strual interval  at  which  conception  takes  place,  will  in  great  measure  influence 
the  duration  of  the  pregnancy  afterwards;  that  where  it  has  occurred  immediately 
after  an  appearance  of  the  menses,  the  uterus  will  have  attained  such  a  dilatation 
and  weight  of  contents  by  the  time  the  ninth  period  has  arrived,  that  it  will  not 
be  able  to  pass  through  this  state  of  catamenial  excitement  without  contraction, 
or,  in  other  words,  labour  coming  on;  hence  it  is  that  we  find  a  considerable 
number  of  labours  fall  short  of  the  usual  time,  so  much  so,  that  some  authors 


128  Revieivs,  [J"ly 

have  even  considered  the  natural  term  of  human  gestation  to  be  273  days,  or  39 
weeks:  for  a  somewhat  similar  reason  we  can  explain  why  primiparae  seldom  go 
to  the  full  term  of  gestation,  the  uterus  being  less  capable  of  undergoing  the  neces- 
sary increase  of  volume  in  a  first  pregnancy  than  it  is  in  succeeding  ones.  On 
the  other  hand,  where  impregnation  has  taken  place  shortly  before  a  menstrual 
period,  the  uterus,  especially  if  the  patient  has  already  had  several  children,  will 
probably  not  have  attained  such  a  volume  and  development  as  to  prevent  its 
passing  the  ninth  period,  without  expelling  its  contents,  but  may  even  go  on  to 
the  next  before  this  process  takes  place;  it  is  in  this  way  that  we  would  explain 
the  cases  related  by  Dr.  Dewees  and  Dr.  Montgomery.  We  are  aware,  that 
under  such  a  view  of  the  subject,  the  duration  of  time  between  the  catamenial 
periods  of  each  individual  should  be  taken  into  account,  some  women  menstru- 
ating at  very  short  and  others  at  very  long  intervals;  but  although  this  will 
affect  the  number  of  periods,  during  which  the  pregnancy  will  last,  it  will  not 
influence  the  actual  duration  of  time,  as  this  will  more  immediately  depend  upon 
the  size  and  weight  of  contents  which  the  uterus  has  attained." 

A  very  excellent  and  instructive  chapter  on  the  premature  expulsion  of 
the  foetus — its  causes,  symptoms,  and  effects,  together  with  the  prophy- 
lactic and  remedial  measures  to  be  pursued,  closes  the  second  part. 

The  third  part  treats  of  Eutocia,  or  natural  parturition. 

The  first  chapter  contains  a  very  full  and  admirable  description  of  the 
coming  on — the  different  stages — progress  and  termination  of  a  case  of 
natural  labour — in  the  preparation  of  which  the  author  acknowledges  his 
frequent  indebtedness  to  the  works  of  Wigand  {Geburt  des  Menschen,) 
and  of  Hohl  [Die  gehurtshulfliche  Exploration).  We  are  acquainted  with 
no  description  of  the  phenomena  of  natural  labour  so  well  adapted  for  the 
instruction  of  the  student — or  one  from  an  attentive  perusal  of  which  the 
young  obstetrical  practitioner  will  be  able  to  glean  so  many  useful  hints. 

A  very  able  chapter  succeeds  on  the  treatment  of  natural  labour.  The 
directions,  in  the  highest  degree  judicious  in  themselves,  are  detailed  with 
sufficient  minuteness  and  clearness,  and  enforced  by  an  exposition  of  the 
reasons  upon  which  they  are  severally  based.  Few  practitioners  of  the 
obstetric  art  remote  from  our  larger  cities,  even  though  they  may  have  de- 
voted years  to  the  profession,  will,  we  suspect,  be  found  who  will  not 
derive  much  instruction  from  a  careful  study  of  this  excellent  chapter. 

In  the  ensuing  chapter  is  considered  the  all  important  subject,  the  me- 
chanism of  parturition,  without  a  thorough  acquaintance  with  which, 
no  one  is  competent  to  take  charge  of  any  case  of  labour — this  being  the 
only  true  basis  upon  which  the  principles  of  practical  midwifery  can  be 
founded. 

"Unless,"  as  the  author  correctly  remarks,  "a  practitioner  be  thoroughly 
acquainted  with  every  step  in  the  mechanism  of  a  natural  labour,  how  can  he  be 
expected  to  understand  and  detect  with  certainty  any  deviation  from  its  usual 
course,  still  less  make  use  of  those  means  which  may  be  required  under  the 
peculiar  circumstances  of  the  case;  and  yet  strange  to  say,  there  are  few  sub- 
jects which,  generally  speaking,  have  excited  so  little  attention,  and  upon  which 
such  incorrect  opinions  have  prevailed  even  up  to  the  present  time." 

Dr.  Rigby  has  endeavoured,  in  the  chapter  before  us,  to  render  this  un- 
questionably difficult  subject  as  clear  as  possible,  and  to  divest  it  of  those 
erroneous  notions,  still  entertained  by  many,  which  have  taken  their  rise  in 
closet  speculations  rather  than  from  a  careful  examination  of  the  actual  man- 
ner in  which  the  child  presents  and  passes  through  the  pelvis  and  soft  parts 
during  labour.     The  chapter  is  a  highly  interesting  and  instructive  one. 


I 


1842.]  "Rx^y's  System  of  Midwifery,  129 

Part  the  fourth  is  devoted  to  a  consideration  of  midwifery  operations. 
The  first  chapter  treats  of  the  forceps,  with  the  indications  for  their  use, 
and  the  rules  for  their  application.  The  second  chapter  is  on  the  opera- 
tion of  turning-,  the  indications  for  its  employment — the  circumstances 
most  favourable  for  its  performance,  and  directions  as  to  the  proper  manner 
in  which  it  should  be  effected.  Both  chapters  exhibit  the  usual  character- 
istics of  our  author  as  a  systematic  writer,  condensation  with  great  clear- 
ness; while  the  practical  directions  detailed  in  them  are  sufficiently  explicit, 
and  throughout  highly  judicious. 

The  Cassarean  operation  is  considered  in  the  third  chapter.  This  is 
one  of  the  few  subjects  connected  with  the  principles  and  practice  of  mid- 
wifery, in  relation  to  which  the  author  has  failed  to  give  a  satisfactory 
view  of  the  present  state  of  our  knowledge.  His  account  of  the  indica- 
tions for  the  performance  of  the  operation  are  certainly  any  thing  but  clear 
and  precise,  and  must  leave  the  reader  in  great  doubt  as  to  the  value  of 
the  operation,  or  the  exact  circumstances  under  which  its  performance  is 
warranted.  While  he  would  appear  inclined  to  admit  of  its  propriety  as  a 
means  of  saving  the  life  of  the  child  as  well  as  that  of  the  mother,  he 
nevertheless,  deterred  probably  by  its  generally  unsuccessful  termination 
in  England,  describes  the  circumstances  under  which  it  becomes  the  duty 
of  the  surgeon  to  perform  the  Caesarean  section  to  be  those  in  which  "  the 
pelvis  is  so  narrow  that  the  child  cannot  be  brought  even  piecemeal  through 
the  natural  passage,"  in  which  case,  even  if  the  child  be  dead,  the  opera- 
tion becomes  unavoidable. 

The  fourth  chapter  treats  of  artificial  premature  labour.  This  Dr.  R. 
considers  as  "  perhaps  the  greatest  improvement  in  operative  midwifery 
since  the  invention  and  gradual  improvement  of  the  forceps." 

The  operation  consists  in  inducing  labour  artificially,  at  such  a  period 
of  pregnancy  as  that  the  child  shall  have  attained  a  sufficient  degree  of  de- 
velopment to  support  its  existence  afterbirth,  and  yet  be  so  small,  and  the 
bones  of  its  head  so  soft,  as  to  be  capable  of  passing  through  the  con- 
tracted pelvis  of  its  mother.  It  is  resorted  to  for  the  purpose  of  giving 
birth  to  a  living  child,  under  circumstances  of  pelvic  contraction,  where 
either  the  mother  must  have  been  exposed  to  the  danger  and  sufferings  of 
the  Caesarian  operation,  or  the  infant  to  the  certainty  of  death  by  perfora- 
tion, or  at  least  where  the  labour  must  have  been  so  severe  and  protracted, 
as  to  have  more  or  less  endangered  the  lives  of  both. 

We  are  happy  to  find  so  distinguished  an  authority  as  Dr.  Rigby,  bear- 
ing so  decided  a  testimony  in  favour  of  the  production  of  premature  labour, 
in  those  cases  in  which  the  delivery  of  the  child  at  the  full  period  is  either 
impossible  or  attended  with  imminent  danger  to  both  mother  and  child. 
In  his  estimateof  the  practicability  and  entire  safety  of  the  operation,  he  is 
sustained  by  some  of  the  most  distinguished  of  the  German  obstetricians. 

"Professor  Kilian,  in  his  work  on  operative  midwifery,  has  collected  the  re- 
sults of  no  less  than  161  cases  of  artificial  premature  labour;  of  these,  72  oc- 
curred in  England,  79  in  Germany,  7  in  Italy,  and  3  in  Holland:  of  these  cases, 
115  children  were  born  alive,  and  46  dead:  of  the  115  living  children,  73  con- 
tinued alive  and  healthy;  8  of  the  mothers  died  after  the  operation;  but  of  these, 
5  were  evidently  from  diseases  which  had  nothing  to  do  with  the  operation. 

"One  great  encouragement,"  Dr.  R.  remarks,  "  in  cases  requiring  this  operation 
is  the  fact,  that  in  every  successive  pregnancy  the  uterus  is  more  easily  excited 
to  premature  action;  and  in  some  cases  where  it  has  been  induced  several  times, 
it  has  at  length,  as  it  were,  got  so  completely  into  the  habit  of  retaining  its  con» 


130  Reviews,  [July 

tents  only  up  to  a  certain  period,  that  labour  has  come  on  spontaneously,  exactly 
at  the  time  at  which  in  the  former  pregnancies  it  had  been  artificially  induced." 

A  very  clear  account  is  given  in  the  chapter  before  us,  of  the  circum- 
stances under  which  the  operation  is  warranted,  the  period  of  pregnancy 
most  favourable  for  its  performance,  and  of  the  proper  manner  of  perform- 
ing it. 

The  next  chapter  treats  of  perforation,  the  cases  in  which  it  is  indicated, 
and  the  mode  of  operating — and  concludes  with  a  brief  notice  of  embry- 
ulcia. 

Part  \\ie  fifth  is  devoted  to  a  consideration  of  Dystocia  or  abnormal  par- 
turition— or  those  labours  which  either  cannot  be  completed  by  the  natural 
powers  destined  for  that  purpose,  or  at  least,  not  without  injury  to  the 
mother  or  child. 

Pursuing  the  arrangement  adopted  by  Professor  Naegele,  Dr.  Rigby 
divides  abnormal  parturition  into  two  classes. 

"  1.  Labours  that  are  difficult  or  impossible  to  be  completed  by  the  natural 
powers. 

"  2.  Labours  which  are  rendered  faulty  without  obstruction  to  their  progress." 

The  first  may  depend  upon  a  faulty  condition  of  the  expelling  powers, 
or  without  any  anormality  in  this  respect,  upon  the  faulty  condition  either 
of  the  child  or  of  the  parts  through  which  it  has  to  pass. 

"As  it  respects  the  child  they  may  arise  from,  1,  malposition;  2,  faulty  form, 
and  size  of  the  child;  3,  faulty  condition  of  the  parts  which  belong  to  the  child 
on  the  part  of  the  mother; — 

"  From  a  faulty  condition,  4,  of  the  pelvis;  5,  of  the  soft  passages;  6,  of  the 
expelling  powers." 

"The  second  condition  where  labour  is  rendered  dangerous  for  the  mother  or 
her  child,  without  any  obstruction  to  its  progress,  may  arise  from — 1.  Follow- 
ing too  rapid  a  course.  2.  Prolapsus  of  the  umbilical  cord.  3.  From  accidental 
circumstances,  which  render  the  labour  dangerous,  viz.  convulsion,  syncope, 
dyspnoea,  severe  and  continued  vomiting,  hemorrhage,  &;c." 

In  the  twelve  chapters  devoted  to  a  consideration  of  each  of  the  above 
species  of  dystocia,  will  be  found,  accurately  detailed,  all  the  more  im- 
portant facts,  derived  from  the  experience  of  the  most  authoritative  writers 
necessary  to  a  correct  understanding  of  the  several  causes,  by  which  the 
natural  course  and  termination  of  labour  may  be  impeded  or  prevented,  with 
the  means  best  adapted  to  prevent,  remove,  or  lessen  the  difficulty — or  to 
effect  the  delivery  of  the  child  without  endangering  the  life  of  both  it  and 
its  mother.  The  author's  account  of  abnormal  labour,  condensed  as  it 
is,  vf\\\  be  found  perfectly  explicit — and  marked  throughout  by  a  sound 
and  discriminating  judgment — founded  evidently  upon  a  careful  study  of 
the  subject  under  circumstances  peculiarly  favourable  to  the  acquisition  of 
sound  practical  views. 

In  considering  the  treatment  of  that  species  of  dystocia  in  which  the 
propulsive  powers  of  the  uterus  are  defective.  Dr.  Rigby  remarks,  that  such 
a  state  of  uterine  inactivity  as  will  warrant  the  use  of  such  remedies  as 
have  the  power  directly  to  excite  the  uterine  contractions  is  extremely 
rare,  and  he  earnestly  warns  young  practitioners  against  too  readily  con- 
cluding that  it  is  present.  They  will  find,  he  remarks,  that  the  more  care- 
fully they  investigate  such  cases,  the  less  frequently  will  they  require  such 
remedies.  In  using  the  secale  cornutum,  he  gives  the  preference  to  the 
powder.     Borax,  according  to  him,  is  also  another  remedy  which  appears 


I 


1842.J  'Righy^s  System  of  Midwifery.  131 

to  possess  a  peculiar  power  in  exciting  the  activity  of  the  uterus;  although 
it  is  scarcely  ever  used  for  such  a  purpose  in  England,  its  effects  upon  the 
uterus  have  been  long  known  in  Germany;  and  in  former  times,  both  it 
and  the  secale  cornutum  entered  largely  into  the  composition  of  the  differ- 
ent nostrums,  which  were  used  for  the  purpose  of  assisting,  labour.  Dr. 
R.  has  combined  these  two  medicines,  with,  as  he  states,  the  best  effects; 
he  generally  gives  them  in  the  following  manner: — R.  Secalis  cornuti  9j- 
ij;  sodae  subborat.  gr.  x;  aq.  cinnamomi  ^jss. — m.  fiat  haust.  Cinnamon, 
which  is  a  remedy  of  considerable  antiquity,  has  also  a  similar  action  upon 
the  uterus,  although  to  a  less  degree. 

"  Our  own  conviction  with  regard  to  the  use  of  these  remedies,"  adds  Dr  .R., 
*'  is,  that  they  are  seldom  required  rfwrm^  labour,  except  in  nates  or  footling  pre- 
sentations, or  in  cases  of  turning,  where  the  head  is  about  to  enter  the  pelvis, 
and  where,  at  this  critical  moment,  the  action  of  the  uterus  is  apt  to  fail,  when 
it  is  important  to  the  safety  of  the  child  that  there  should  be  brisk  pains  to  force 
the  head  through  the  pelvis  and  internal  parts  with  sufficient  rapidity.  The 
chief  value  of  these  remedies  is  for  the  purpose  of  exciting  uterine  contraction 
after  labour,  and  thus  to  promote  the  safe  expulsion  of  the  placenta,  where  there 
is  a  disposition  to  inertia  uteri,  and  insure  the  patient  against  hemorrhage. 
Where  the  contractile  power  of  the  uterus  is  so  enfeebled  that  it  becomes  nearly 
powerless,  we  deem  it  much  safer  and  better  to  apply  extractive  force  to  the 
head  by  means  of  the  forceps,  and  thus  overcome  the  natural  resistance  of  the 
soft  parts,  to  using  medicines  which  excite  uterine  action,  and  thus  stimulate  the 
exhausted  organs  to  still  farther  efforts." 

A  very  sensible  chapter  is  given  on  the  causes,  diagnosis,  symptoms  and 
treatment  of  inversion  of  the  uterus. 

In  the  eleventh  chapter  of  this  division  of  the  work.  Dr.  Rigby  treats  of 
puerperal  convulsions.  The  description  of  the  different  forms  of  convul- 
sions that  occur  previous  to,  during  and  subsequent  to  labour  are  all  ably 
described — the  facts  bearing  upon  their  pathology  clearly  stated,  and  the 
remedial  measures  which  experience  has  shown  to  be  best  adapted  to  their 
prevention  and  cure  accurately  detailed. 

Puerperal  fevers  is  the  subject  of  the  thirteenth  chapter.  The  author's 
very  full  and  able  account  of  these  affections,  which  are  certainly,  as  he 
truly  remarks,  the  most  to  be  dreaded  of  any  to  which  a  lying-in  woman  is 
exposed,  constitutes  unquestionably  one  of  the  most  interesting  and  im- 
portant portions  of  the  excellent  volume  before  us. 

After  an  examination  into  the  nature  and  varieties  of  puerperal  fever, 
replete  with  sound  pathological  views,  calculated  to  lead  to  more  precise 
and  correct  views  in  regard  to  the  causes  and  character  of  the  disease,  the 
author  proceeds  to  consider  its  several  forms,  under  the  heads  of  puerperal 
peritonitis — uterine  phlebitis — false  peritonitis^and  gastro-bilious — and 
contagious  or  adynamic  puerperal  fevers. 

"The  vitiation  of  the  blood,^^  Dr.  Rigby  remarks, "  has  long  been  a  subject  which 
has  excited  our  deepest  interest,  and  the  admirable  researches  of  Dr.  Stevens 
upon  the  condition  of  this  fluid  under  the  effects  of  malignant  fevers,  have 
tended  to  disclose  the  real  nature  of  the  diseases  under  consideration.  We  have 
long  been  convinced  that  one  of  the  causes  of  puerperal  fever  is  the  absorption 
of  putrid  matters,  furnished  by  the  coagula  and  discharges,  which  are  apt  to  be 
retained  in  the  uterus  and  passages  after  parturition, — a  view  which  has  been 
adopted  by  Kirkland,  C.  White,  and  other  older  writers.  It  is  with  sincere 
pleasure  that  we  now  find  ourselves  supported  by  Dr.  Ferguson  in  this  opinion." 

"We  do  not  agree  with  him  in  supposing  that  every  form  of  puerperal  in- 


132  Reviews,  [Ju^y 

flammation  is  produced  by  vitiation  of  the  circulating  fluids,  because  in  one 
species  of  uterine  phlebitis,  which  occurred  sporadically,  and  prevailed  a  good 
deal  from  1829  to  1832,  it  was,  in  our  opinion,  evidently  produced  directly  by 
the  absorption  of  putrid  matter  into  the  uterine  veins  and  lymphatics,  exciting 
inflammation  in  these  vessels;  the  same  cause,  when  only  carried  to  a  certain  ex- 
tent, produces  a  local  inflammation,  which,  when  affecting  the  general  circula- 
tion, is  followed  by  fever — the  local  and  constitutional  disturbance  arising  from 
the  same  cause,  imbibition  or  absorption  of  putrid  matter,  the  one  being  the 
local,  the  other  the  general  effect,  but  not  the  one  resulting  from  the  other.  The 
doctrine  of  the  vitiation  of  the  blood  from  its  admixture  with  pus  secreted  by 
the  lining  membrane  of  an  inflamed  vein,  though  very  plausible,  still  requires 
further  confirmation,  for  it  is  doubtful  if  the  introduction  of  pure  healthy  pus 
into  the  circulation  produces  any  of  those  dangerous  effects  whicli  result  from 
the  introduction  of  putrid  matters,  whether  purulent,  sanious,  mucous,  &c.  It  is 
the  introduction  of  an  animal  poison  generated  by  putrefaction,  which  destroys 
the  vitality  of  the  blood,  and  renders  it  unfit  for  maintaining  the  vital  powers." 

Dr.  Rigby  does  not,  however,  refer  the  cause  of  puerperal  fever  solely 
to  the  absorption  of  putrid  matters  by  the  uterine  veins  and  lymphatics, 
but  to  the  still  more  pervading  and  truly  epidemic,  and  contagious  action 
of  the  miasmata,  with  which  the  air  that  surrounds  the  patient  is  charged. 
The  lungs,  he  remarks,  afford  a  ready  and  ample  means  by  which  efifliuvia 
may  be  conveyed  into  the  circulating  current. 

Under  the  inflammatory  form  of  puerperal  fever.  Dr.  R.  considers  as 
well  that  form  of  acute  peritonitis,  so  ably  described  by  Dr.  Locock,  which 
is  chiefly  produced  by  the  efl^'ects  of  labour,  and  in  the  treatment  of  which 
the  lancet  and  other  antiphlogistic  remedies  are  demanded  to  a  greater  or 
less  extent,  but  also  that  form  which,  according  to  Dr.  Ferguson,  arises 
from  vitiation  of  the  blood,  by  the  introduction  of  putrid  matter  into  the 
circulation,  commencing  with  the  symptoms  of  uterine  phlebitis,  but  ter- 
minating invariably,  if  not  stopped  at  an  early  period,  in  peritonitis — a 
form  of  the  disease  which,  according  to  our  author,  has  not  only  a  great 
disposition  to  assume  a  typhoid  character,  but  also  to  become  epidemic. 

In  this  form  of  the  disease  Dr.  R.  directs  great  caution  in  the  use  of  the 
lancet  and  other  depletory  remedies.  He  has  become  more  than  ever  con- 
vinced, from  the  results  of  his  own  experience  and  other  considerations, 
that  it  is  not  a  remedy  which  is  alivays  to  be  premised  before  the  em- 
ployment of  other  remedies,  as  in  cases  of  simple  inflammation  of  the 
viscera  or  serous  membranes. 

"  The  only  circumstances  we  apprehend,"  he  adds,  "  under  which  venesection 
ought  to  be  employed  in  this  form  of  the  disease,  are  where  the  pain  is  constant, 
without  intermission,  and  where,  besides  its  rapidity,  the  pulse  betrays  a  degree 
of  wiry  resistance  to  the  finger,  which  can  never  be  mistaken.  In  this  case  the 
blood  drawn  will  show  all  the  usual  marks  of  inflammation,  and  the  relief  pro- 
cured will  be  proporiionably  great." 

The  doctor  directs,  in  cases  of  uterine  phlebitis,  the  patient  to  be  placed 
in  such  a  posture,  as  to  favour  the  escape  of  any  coagula  and  discharges, 
which  may  have  been  stagnating  in  the  uterus  or  vagina;  to  effect  which 
more  completely,  a  stream  of  warm  water  should  be  thrown  up  briskly  into 
the  uterus.  To  increase  the  action  of  all  the  excretory  functions,  and  thus, 
as  far  as  possible,  remove  the  virus,  which  may  have  already  entered  the 
system.  Dr.  R.  conceives  that  the  administration  of  calomel  in  doses  of  ten 
grains,  combined  with  James's  or  antimonial  powder,  is  one  of  the  most 
eflfective  means  we  possess.    When  there  has  occurred  evident  abatement 


1842.]  Righy^s  System  of  Midwifery,  133 

or  remission  of  pain,  he  directs  the  calomel  to  be  combined  with  an  equal 
quantity  of  Dover's  powder  in  the  form  of  pills;  the  calomel  to  be  followed 
in  a  few  hours,  or  if  given  over  night,  in  the  morning,  by  a  solution  of  sul- 
phate and  carbonate  of  magnesia.  To  relieve  pain,  and  promote  perspira- 
tion, hot  lintseed  meal  poultices  are  directed  to  the  abdomen — to  be  con- 
tinued until  the  pain  has  entirely  ceased;  the  vagina  being  well  syringed 
with  warm  water,  from  time  to  time  as  occasion  requires. 

In  the  sections  which  treat  of  gastro-bilious  and  the  contagious  or 
adynamic  forms  of  puerperal  fever,  will  be  found  a  very  excellent  digest 
of  the  present  state  of  our  knowledge  in  relation  to  their  diagnostic  phe- 
nomena, pathology  and  treatment. 

The  propriety  of  direct  depletion  in  this  latter  form  of  the  disease  has 
been  a  question  of  much  dispute  among  physicians,  some  insisting  upon 
its  early  and  full  employment  as  essential  to  the  successful  treatment  of  at 
least  the  majority  of  cases,  while  others  proscribe  it  entirely  as  not  only 
useless,  but  decidedly  prejudicial.  Upon  this  important  point  of  practice 
the  author  makes  the  following  judicious  remarks: 

"  There  is  no  doubt  that,  wherever  the  state  of  the  patient  will  permit  it,  the 
lancet  should  be  tried.  Where  the  pulse  is  quick  and  small  with  little  power,  it 
is  scarcely  more  than  an  experiment  to  ascertain  how  the  system  will  bear  the 
bleeding:  in  the  worst  cases  of  the  adynamic  form,  uncomplicated  by  the  slight- 
est effort  at  reaction,  the  state  of  collapse  at  once  forbids  such  an  attempt:  but  in 
many  instances  the  circulation  is  merely  oppressed,  the  pulse  rises  in  volume  as 
the  depletion  proceeds;  and  where  from  its  feel  before  the  operation  we  had  little 
hopes  of  taking  away  more  than  five  or  six  ounces,  we  are  often  enabled  to  con- 
tinue it  until  a  considerable  quantity  is  lost.  In  other  cases  frightful  exhaustion 
is  the  immediate  effect,  and  warn  us  instantly  to  discontinue  it.  The  capability 
of  bearing  bleeding  may  be  always  looked  upon  as  a  favourable  prognostic,  not 
only  because  the  patient's  strength  is  better  than  we  had  perhaps  expected,  but 
also  because  these  are  precisely  the  cases  where  mercury  can  be  used  with  de- 
cided benefit;  whether  it  be  the  bleeding,  which  in  all  probability  renders  the 
system  more  easily  brought  under  the  influence  of  this  medicine,  we  will  not 
stop  to  consider;  at  any  rate,  its  effects  are  not  only  more  easily  obtained,  but 
they  exert  a  more  decided  control  over  the  progress  of  the  disease;  the  pain 
abates,  the  tympanitic  abdomen  becomes  less  tense,  the  pulse  slower,  fuller,  and 
softer,  the  tongue  moister,  and  there  is  a  sense  of  general  improvement  in  the 
patient's  feelings.  But  in  the  adynamic  form,  when  present  in  its  greatest  in- 
tensity, either  there  is  not  sufficient  time  to  impregnate  the  system,  or  it  is  less 
sensible  to  its  effects:  at  any  rate,  even  if  we  succeed  in  producing  salivation, 
little  or  no  improvement  follows." 

Phlegmasia  Dolens  is  the  subject  of  the  fourteenth  chapter.  This  affec- 
tion Dr.  Rigby  attributes  to  inflammation  and  obstruction  of  the  main  lym- 
phatic trunks  leading  to  the  aflected  limb.  He  denies  that  it  is  invariably 
dependent  upon  inflammation  of  the  iliac  and  femoral  veins  as  maintained  by 
Dr.  Lee,  and  even  when  phlebitis  of  these  vessels  is  present,  he  considers 
that  the  production  of  the  disease  is  to  be  accounted  for  by  the  inflammation 
spreading  to  the  surrounding  fascia  or  cellular  tissue  through  which  the 
larger  lymphatics  of  the  thigh  pass  in  their  way  to  the  abdominal  cavity. 

The  causes  of  the  disease  Dr.  R.  considers  as  of  precisely  the  same 
character  as  those  of  uterine  phlebitis;  the  absorption  or  imbibition,  namely, 
of  putrid  matter  from  the  cavity  of  the  uterus. 

'I'he  treatment  recommended  is,  to  apply  leeches  to  the  seat  of  the  pain 
and  tension,  followed  by  cold  evaporating  washes,  or  even  the  application  of 
ice  over  the  femoral  ring.  Internally,  calomel  is  to  be  administered  to  such 
No.  VII.— July,  1842.  '  12 


134  Reviews,  [July 

an  extent  as  to  affect  the  system,  and  when  the  local  pain  has  ceased,  a 
plaster  of  camphorated  mercurial  ointment  over  the  affected  part;  when  the 
acute  stage  of  the  disease  is  past,  quinine  with  gentle  frictions  of  the  affect- 
ed limb  v/ith  the  compound  camphor  liniment. 

An  account  of  puerperal  mania;  the  different  forms  under  which  it 
occurs,  its  causes,  symptoms  and  treatment,  closes  the  volume. 

Our  very  favourable  estimate  of  the  value  of  the  present  system  of  mid- 
wifery will  have  been  perceived  by  the  remarks  already  made;  we  can 
with  great  confidence  recommend  it  to  the  younger  members  especially  of 
the  profession,  as  a  work  they  will  feel  inclined  frequently  to  consult.  As 
a  text  book  for  the  use  of  the  student  of  the  obstetric  art  we  know  of  none 
superior, 

D.  F.  C. 


1842.]  135 


BIBLIOGRAPHICAL   NOTICES. 


Art.  XIII. — Lectures  on  the  Diagnosis^  Pathology  and  Treatment  of  the  Diseases 
of  the  Chest. — By  W.  W.  Gerhard,  M.  D.,  Lecturer  on  Clinical  Medicine  to  the 
University  of  Pennsylvania,  &c.  &c.  Philadelphia:  Haswell  &  Barrington, 
1842,  8vo. 

These  lectures  of  Dr.  Gerhard,  originally  published  in  the  Medical  Examiner 
during  the  years  1840-1,  have  been  collected  by  the  author  in  a  separate  volume, 
with  such  alterations  and  corrections  as  this  change  seemed  to  indicate.  In 
their  present  form,  therefore,  the)'^  may  be  regarded  as  a  well  digested  summary 
of  the  author's  opinions  on  a  very  important  and  interesting  class  of  diseases. 
An  attentive  perusal  cannot  fail,  we  think,  to  convince  every  one  that  they  con- 
tain not  only  the  evidences  of  an  extensive  acquaintance  with  the  best  received 
opinions  on  these  diseases,  but  the  results  of  much  personal  observation.  Those 
parts  of  the  work  which  strike  us  most  favourably  are,  that  portion  devoted  to 
the  pathology  of  thoracic  diseases,  to  which  we  conceive  it  would  be  very  diffi- 
cult to  add  anything  of  importance,  and  that  devoted  to  the  general  exposition 
of  the  physical  signs.  Dr.  G.  has  devoted  a  large  space  to  the  latter  subject, 
and,  as  we  think,  has  established  its  just  importance  and  value  in  the  diagnosis 
of  thoracic  disease,  and  in  the  most  satisfactory  manner. 

We  make  these  general  remarks  on  the  work  before  us  without  intending  to 
enter  into  a  particular  analysis  of  its  merits.  Indeed  it  would  be  impossible  to 
do  this  in  relation  to  a  work  embracing  such  a  variety  of  topics,  without  going 
very  far  beyond  the  limits  of  a  bibliographical  notice.  Having  then  expressed 
our  very  favourable  opinion  of  the  work  as  a  whole,  and  wishing  to  recommend 
it  to  the  careful  study  of  those  interested  in  the  subjects  of  which  it  treats,  we 
will  simply  allude  to  a  few  points  which  do  not  strike  us  quite  so  favourably. 

Although  the  general  style  of  these  lectures  is  simple,  unpretending,  and  we 
may  add  clear,  yet  there  is  sometimes  a  want  of  distinctness  in  placing  great 
and  leading  principles  and  facts  before  the  reader  which  is  certainly  objection- 
able. We  are  well  aware  that  in  a  lecture  this  can  be  best  done  by  the  manner  of 
delivery,  but  in  a  published  lecture,  especially,  when  revised  expressly  for  pub- 
lication, the  want  of  this  should  have  been  supplied  by  increased  force  of  expres- 
sion and  a  change  in  the  arrangement  of  certain  parts.  If  we  examine  particular 
portions  of  the  work  we  shall  see  this  defect  extremely  conspicuous.  Take  for 
instance  the  lecture  on  the  valvular  diseases  of  the  heart.  We  question  very 
much  whether  the  inexperienced  student  would  derive  any  very  clear  or  satisfac- 
tory ideas  from  its  perusal.  Indeed  the  whole  of  this  part  of  the  subject  (the 
diseases  of  the  heart)  appears  to  us  to  be  treated  in  a  much  less  satisfactory 
manner,  if  we  except  pericarditis,  than  that  relating  to  the  lungs.  For  ourselves 
we  are  inclined  to  believe  that  the  diagnosis  of  these  cardiac  affections  is  far 
more  advanced  and  certain  than  Dr.  Gerhard  would  lead  us  to  believe. 

J.  A.  S. 


136  Bibliographical  Notices,  [Ju^y 


Art.  XIV.  1.  Second  Annual  Report  of  the  Directors  of  the  Marine  Insane  HoS' 
pital.     December^  1841.     Augusta,  Me.,  1841,  pp.  56. 

2.  Ninth  Annual  Report  of  the  Trustees  of  the  State  Lunatic  Hospital,  at  Worcester , 
{Mass.)     December,  1841.     Boston,  1842,  pp.  102. 

3.  State  of  the  New  York  Hospital  and  Bloomingdale  Asylum,  for  the  year  1841. 
New  York,  1842,  pp.  132. 

4.  Twenty-ffth  Annual  Report  on  the  State  of  the  "  Asylum  for  the  Relief  of  Per' 
sons  deprived  of  the  use  of  their  Reason^     Philadelphia,  1842,  pp.  30. 

5.  Third  Annual  Report  of  the  Directors  and  Superintendent  of  the  Ohio  Lunatic 
Asylum,  to  the  Fortieth  General  Assembly.     Columbus,  (Ohio,)  1841,  pp.  60. 

6.  Annual  Report  of  the  Court  of  Directors  of  the  Western  Lunatic  Asylum,  to  the 
Legislature  of  Virginia;  with  the  Report  of  the  Physician,  for  1841.  Richmond, 
Va.,  1842,  pp.  80. 

7.  Report  of  the  Superintendent  of  the  Eastern  Lunatic  Asylum,  Williamsburg, 
Virginia,  from  July  1st,  1841,  to  December  3\st,  1841. 

8.  Extracts  from  a  Lecture  on  Insanity;  delivered  before  the  Young  Men'^s  Associa- 
tion  (fthc  city  of  Utica.     February  ].8th,  1842.     By  C.  B.  Coventry,  M.  D. 

9.  What  shall  we  do  with  the  Insane  of  the  Western  Country?  By  Edward  Jarvis, 
M.  D. 

1 0.  Fifth  Annual  Report  of  the  Trustees  of  the  Vermont  Asylum  for  the  Insane,^ 
October  25th,  1841. 

1 1.  Report  of  the  Trustees  of  the  State  Lunatic  Asylum,  with  the  documents  accom^ 
panying  the  same,  to  the  Legislature  of  the  State  of  New  York.  pp.  203. 

As  faithful  chroniclers  of  the  progress  of  our  profession  in  all  its  departments, 
our  duty  leads  us  to  record  the  current  medical  history  of  the  public  insti- 
tutions for  the  insane,  while  our  admiration  for  a  noble  philanthropy  renders  that 
duty  a  pleasure.  In  regard  to  the  rapid,  efficient,  practical  improvement  in  the 
means  for  the  comfortable  accommodation  and  judicious  treatment  of  those 
afflicted  with  mental  alienation,  the  annals  of  the  world  can  probably  furnish  no 
parallel  to  the  United  States.  The  actual  progress  in  the  establishment  of 
lunatic  asylums  in  this  country,  is  thus  noticed  in  the  Sixteenth  Annual  Report 
of  the  Prison  Discipline  Society. — "It  appears  that  one  institution  was  estab- 
lished, and  another  used  for  the  insane,  in  the  eighteenth  century.  Two  were 
established  in  the  first  twenty  years  of  the  nineteenth  century;  three  from  1820 
to  1830;  eight  from  1830  to  1840;  and  six  are  opened,  provided  for,  or  being 
built  in  1840  and  1841,  besides  much  preparation  for  three  others."  The  last 
annual  reports  of  several  of  these  institutions  being  now  before  us,  we  proceed 
to  collect  therefrom  the  most  important  and  valuable  facts. 

1,  During  the  past  year,  the  number  of  admissions  into  the  Maine  Insane 
Hospital  was  105,  of  which  62  were  of  men,  and  43  of  women.  Discharged  in 
the  same  time,  79.  Of  the  105  admissions,  45  were  of  less  duration  than  one 
year,  and  60  were  of  longer  standing.  Of  the  79  discharged,  38  were  recent 
cases,  of  which  27  recovered,  and  3  died;  and  41  were  chronic,  of  which  6  re- 
covered, and  3  died.  Per  centage  of  deaths  on  the  whole  number  in  the  hospital, 
4.5.  The  elaborate  report  of  Dr.  Ray,  the  superintending  physician,  is  chiefly 
devoted  to  an  exposition  of  the  object  of  asylums  for  the  insane,  their  paramount 
utility  in  the  treatment  of  mental  disorders,  and  the  great  importance  of  resorting 
to  them  in  the  early  stages  of  the  disease.  This  is  intended  particularly  for  the 
people  of  Maine,  in  order,  by  giving  them  accurate  ideas  of  the  disease  and  of 
its  appropriate  remedies,  to  induce  them  to  avail  themselves  of  the  benefits  of 
the  institution  more  generally  than  has  hitherto  been  done.  The  sentiments 
contained  in  one  portion  of  this  report  are  so  frequently  met  with  in  the  similar 
publications  of  other  asylums,  and  their  importance  being  such  as  to  require  a 
wide  dissemination,  we  extract  the  paragraph  entire.  "Above  all  things,  in 
order  to  obtain  the  confidence  of  our  patients,  we  find  it  necessary  to  abstain 
from  every  kind  of  deception  in  our  dealings  with  them.     Nothing  irritates  an 


I 


1842.]  Reports  of  Insane  Hospitals.  137 

insane  person,  or  paralyses  the  efforts  of  others  to  help  him,  more  than  decep- 
tion, which,  with  his  strong  disposition  to  suspicion,  inevitably  makes  an  unfa- 
vourable impression  upon  his  mind.  Whenever  he  discovers  it,  and  sooner  or 
later  he  will,  he  regards  the  author  of  it  as  one  of  his  enemies,  who  are  banded 
together  to  deceive,  tease  and  harass  him.  If  people  were  generally  aware  of 
this  trait  in  the  insane,  they  would  be  more  cautious  how  they  endeavour  to 
obtain  the  smallest  point  by  any  other  than  honest  and  straightforward  means. 
Scarcely  a  patient  is  brought  to  us  who  has  been  correctly  informed  respecting 
the  nature  of  the  place  he  is  going  to,  or  how  long  he  is  to  remain.  The  conse- 
quence is,  when  he  discovers  the  deception,  that  he  imbibes  an  aversion  towards 
his  friends  that  may  not  very  easily  be  overcome,  and  looks  upon  us  as  parties 
to  the  wrong  that  has  been  done  him.  Thus,  at  the  very  outset,  we  are  met  by 
a  serious  difficulty  which  it  may  require  weeks  or  months  for  us  to  remove." 

2.  The  Ninth  Report  of  the  Massachusetts  State  Lunatic  Hospital,  like  all 
which  have  emanated  from  the  pen  of  Dr.  Woodward,  is  fraught  with  subjects 
of  deep  interest  to  the  physician,  the  philanthropist,  and  all  who  regard  the  wel- 
fare of  suffering  humanity.  During  the  past  year,  73  men  and  90  women,  a 
total  of  163  patients,  have  been  received  into  this  hospital.  These,  with  the 
236  remaining  at  the  commencement  of  the  year,  make  399  who  have  enjoyed 
the  benefits  of  the  institution  during  that  period.  Discharged  or  died,  men  77, 
women  90.  Of  the  former,  38  were  restored,  and  7  died;  of  the  latter,  44  were 
restored,  and  5  died.  Of  the  admissions,  84  were  recent  cases,  and  79  chronic. 
Of  the  discharges,  68  were  recent  cases,  of  which  62  were  restored,  and  4  died; 
and  99  were  chronic,  of  which  20  were  restored,  and  8  died.  At  the  close  of 
the  year,  there  remained  in  the  hospital  116  men,  and  116  women;  total,  232. 
The  daily  average  number  of  patients,  for  the  year,  was  233.  The  report  states 
that  the  hospital  is  always  full,  and  during  the  past  year,  91  applications  have 
been  rejected  for  want  of  room. 

During  the  nine  years  that  the  hospital  has  been  in  operation,  1359  patients 
have  been  admitted,  of  whom  710  were  men,  and  649  women.  Single,  715; 
married,  508;  widows,  88;  widowers,  48.  The  whole  number  of  recoveries  was 
588;  of  deaths,  102.  According  to  Dr.  Woodward's  observations,  "spring 
affords  the  greatest  number  of  cases,  autumn  the  greatest  number  of  recoveries, 
and  summer  the  greatest  number  of  deaths." 

We  extract  the  following  paragraph,  because  its  testimony  goes  to  controvert 
a  generally  received  opinion  in  regard  to  the  age  at  which  insanity  is  the  most 
susceptible  of  cure. 

"It  still  continues  to  be  an  interesting  fact,  deducible  from  our  records,  that 
persons  attacked  with  insanity  after  40  years  of  age,  recover  in  much  greater 
proportion  than  those  attacked  before  that  age." 

The  number  of  patients  in  each  decennium  of  life,  admitted  during  the  nine 
years,  was  as  follows: — Under  20  years  of  age,  79;  between  twenty  and  thirty, 
356;  thirty  and  forty,  383;  forty  and  fifty,  275;  fifty  and  sixty,  144;  sixty  and 
seventy,  88;  seventy  and  eighty,  35;  over  eighty,  1. 

Of  99  patients  who  have  died,  (the  proper  data  whereon  to  base  the  calcula- 
tion, not  being  attainable  in  the  remaining  6,)  the  average  age  at  the  commence- 
ment of  the  disease  was,  in  men,  41  years,  6  months;  in  women,  42  years,  3 
months;  mean,  41  years,  10  months,  15  days.  The  average  duration  of  life  after 
the  individuals  became  insane,  was,  in  men,  6  years,  5  months,  19  days;  in 
women,  3  years,  3  months,  12  days;  mean,  4  years,  4  months,  ISi  days.  The 
average  age  at  which  the  99  died  was,  in  men,  47  years,  2  months;  in  women, 
45  years,  6  months,  12  days;  mean,  46  years,  4  months,  6  days. 

In  a  large  number  of  paroxysmal  cases,  the  commencement  of  the  paroxysms 
have  been  observed  in  reference  to  the  several  phases  of  the  moon.  After  hav- 
ing stated  the  results  of  these  observations.  Dr.  Woodward  says: — "These 
facts  and  coincidences  we  leave  for  the  present,  with  the  single  remark,  that  no 
theory  seems  to  be  supported  by  them,  which  has  existed  either  among  the  igno- 
rant or  the  wise  men  who  have  been  believers  in  the  influence  of  the  moon  upon 
tlie  insane." 

12* 


138  Bibliographical  Notices.  [July 

An  impression  prevails  to  some  extent  in  the  community,  and  particularly 
among  the  members  of  the  medical  profession,  that  the  superintendent  of  the 
hospital  at  Worcester  professes  to  effect  a  restoration  of  the  insane,  in  a  far 
greater  proportion  of  the  cases  under  treatment,  than  has  heretofore  been  the 
result  in  other  institutions  of  the  kind.  This  impression  we  believe  to  be  erro- 
neous. It  certainly  is  not  sustained  by  the  facts  embodied  in  his  reports.  We 
quote  his  own  language  from  the  report  before  us.  "The  average  of  recoveries 
of  cases  of  less  duration  than  one  year,  is  now  88  per  cent,  for  the  whole  time, 
and  is  as  great  as  can  ever  be  expected.  The  per  cent,  of  all  the  recovered  on  all 
the  admissions  in  this  hospital,  is  r\ovf  forty -three  and  one-third,,  and  the  per  cent, 
of  discharges  recovered,  on  the  admissions  this  year,  is  fifty  and  one-third." 
The  proportion  (88  per  cent.)  of  recent  cases,  above-mentioned,  is  upon  the  dis- 
charges. In  another  place,  he  states  that  the  proportion  of  cures  of  recent  cases 
on  the  whole  number  of  admissions  is  83.75  per  cent.,  and  of  chronic  cases 
20.33  per  cent.  Setting  aside  the  distinction  between  recent  and  chronic  cases, 
and  adopting  the  only  unambiguous  basis  of  comparison,  that  of  the  proportion 
of  cur(;s  on  the  whole  number  of  admissions,  we  proceed  to  notice  the  results  in 
some  of  the  British  institutions.  At  the  Retreat,  near  York,  Eng.,  the  cures 
during  forty-four  years,  ending  in  1840,  were  equivalent  to  47.31  per  cent.;  at 
the  Exeter  Asylum,  from  1801  to  1840,  52.43  per  cent.;  at  Bethlehem  Hospital, 
London,  from  1829  to  1840,  50.96  per  cent.;  at  the  Gloucestershire  Asylum, 
from  1823  to  1832,  44.94  per  cent.;  at  the  Asylum  at  Wakefield,  from  1818  to 
1841,  44.18  per  cent.;  at  the  Asylum  of  Aberdeen,  Scotland,  from  1830  to  1840, 
45.12  per  cent.;  and  at  the  Armagh  Asylum,  Ireland,  from  1825  to  1840,  45.27 
per  cent.  In  all  of  these,  as  well  as  in  several  other  British  institutions,  the 
proportion  of  cures  exceeds  that  at  Worcester;  while,  on  the  contrary,  at  the  asy- 
lums of  Kent,  Lancaster,  Hanv/ell,  Nottingham,  St.  Luke's  of  London,  Lincoln, 
Dundee,  Montrose,  Connaught,  Waterford,  and  some  others,  the  similar  propor- 
tion is  less  than  that  at  Worcester.  The  average  per  cenlage  of  cures  in  eleven 
Irish  asylums,  is  stated  at  45.91,  which  exceeds  by  k58  that  at  Worcester. 
While  we  are  fully  sensible  that  an  accurate,  detailed  comparison  of  the  results 
of  different  asylums  can  be  effected  in  no  way  other  than  by  a  consideration  of 
numerous  circumstances  and  conditions  in  the  nature,  organization  and  rules  of 
the  institutions  themselves,  yet  we  believe  that  the  comparison  here  instituted 
does  not  sufficiently  involve  those  conditions  to  prevent  an  approximation,  at 
least,  towards  the  truth.  It  has  been  made  with  no  other  motive  than  that  sug- 
gested above — to  correct  an  erroneous  impression.  While  we  have  shown  that 
the  results  of  several  institutions  have  been  more  favourable  than  those  at  Wor- 
cester, we  are  firmly  convinced  that  all  other  conditions  and  influences  being 
equal,  the  asylum  under  the  care  of  Dr.  W.  would  present  as  large  a  proportion 
of  cures  as  any  other. 

3.  Although  foreign  to  the  special  object  of  this  notice,  yet  as  conveying 
important  information,  we  quote  the  following  synopsis  of  the  results  of  treat- 
ment in  the  New  York  Hospital.  "The  number  of  patients  in  the  Hospital  on 
the  31st  of  December,  1840,  was  187;  and  there  were  admitted  during  the  year 
1841,  2000;  making  a  total  of  2187  persons  who  have  received  the  benefits  of 
the  institution  in  the  course  of  the  year.  Of  this  number,  there  have  been  cured 
1501;  relieved,  84;  discharged  on  their  own  request,  163;  discharged  as  impro- 
per subjects,  26;  eloped  or  discharged  as  disorderly,  40;  died,  193;  remaining, 
180." 

By  the  comparatively  brief,  but  well  written  report  of  Dr.  Wilson,  of  the 
Bloomingdale  Asylum,  a  detached  department  of  the  New  York  Hospital,  it 
appears  that  the  number  of  patients  in  that  institution,  at  the  commencement  of 
the  year,  was  131;  admitted  during  the  year,  102;  total,  233.  Discharged  or 
died  during  the  same  period,  100;  remaining  at  the  close  of  the  year,  133.  Of 
the  102  admissions,  71  were  of  recent,  and  31  of  chronic  cases.  Of  the  dis- 
charges, 58  were  recent,  of  which  46  were  cured,  and  5  died;  42  were  chronic, 
of  which  9  were  cured,  and  13  died.  "The  number  of  deaths  during  the  year," 
says  the  report,  "  has  been  unusually  large;  not  the  consequence  of  any  epide- 


1842.]  Reports  of  Insane  Hospitals,  139 

mic,  but  rather  of  the  accumulation  of  old  cases,  and  the  necessary  progress  and 
termination  of  extensive  organic  disease."  This  asylum  "rejects  no  application 
for  admission,  whatever  the  state  or  condition  of  the  patient,  curable  or  incura- 
ble, in  ordinary  physical  health,  or  in  articulo  mortis.'''* 

The  following  tabular  extract  exhibits  the  most  important  result  of  treatment, 
from  1823  to  1841  inclusive:— 

Admitted.  Recovered.  Per  cent. 

Chronic  cases,  1037  120  11.5 

,  Recent       "  1336  1020  76.33 

The  following  table  is  more  elaborate,  and  includes  a  greater  number  of  cases, 
being  all  those  admitted  from  1821  to  1841  inclusive. 

Men.  Women.  Total.  Died. 

Admitted,  1692  906  2598  240 

Recovered,         848  352  1200 


Percent.  50.12  38.84  46.20  9.25 

4.  The  number  of  patients  at  the  Frankford  Asylum,  at  the  commencement 
of  the  year,  was  58;  admitted  during  the  year,  39;  discharged,  36;  died,  3;  re- 
maining at  the  end  of  the  year,  58.  Of  the  36  discharged,  there  were  restored, 
13;  much  improved,  4;  improved,  iO;  stationary,  9.  Five  of  those  discharged, 
unrestored,  were  apparently  curable,  and  would  probably  have  recovered  had 
they  remained  a  sufficient  length  of  time  under  of  treatment.  The  proportion  of 
chronic  and  incurable  cases,  among  those  admitted,  was  unusually  large.  Dur- 
ing the  twenty-five  years  that  this  asylum  has  been  in  operation,  the  number  of 
admissions  has  been  784.  Of  these,  149  were  re-admissions  of96  individuals,  leav- 
ing but  635jOfrsons  received  as  patients.  Of  these  635,  263  were  restored,  65  much 
improved,  and  87  died.  "  Of  the  96  patients  re-admitted,  there  were  discharged 
restored,  49;  much  improved,  4;  improved,  10;  stationary,  9;  died,  17;  remain- 
ing, 7.  Twenty-eight  were  admitted  a  third  time;  of  whom  there  were  dis- 
charged, restored,  16;  improved,  3;  stationary,  5;  died,  2;  remaining,  2.  Eight 
were  admitted  a  fourth  time,  of  whom  6  were  restored,  1  much  improved,  and 
1  died.  Two  returned  a  fifth  time,  of  whom  one  is  stationary,  and  the  other 
recovering;  one,  a  sixth  time,  and  was  discharged,  recovered;  and  two  ten 
times  each,  of  whom  one  died,  and  the  other  recovered." 

5.  In  the  Ohio  Lunatic  Asylum,  there  were,  at  the  commencement  of  the  year, 
138  patients,  73  men  and  65  women.  Admitted  during  the  year,  85;  discharged, 
81;  remaining  at  the  end  of  the  year,  142.  Average  number  during  the  year, 
143.  Of  those  discharged,  there  were  44  recovered,  5  improved,  18  incurable; 
and  14  died. 

During  the  three  years  since  this  asylum  was  opened,  186  men  and  157  wo- 
men, a  total  of  343  patients,  have  been  received.  In  the  same  period,  201  have 
been  discharged,  of  whom  there  were  recovered,  124;  improved,  II;  incurable, 
28;  idiotic,  2;  died,  36.  Of  the  343  admitted,  171  were  single,  135  married, 
26  widows,  and  11  widowers.  Arranged  according  to  their  ages  at  the  time  of 
admission,  they  are  as  follows: — Under  20  years,  13;  between  twenty  and  thirty, 
137;  thirty  and  forty,  91;  forty  and  fifty,  61;  fifty  and  sixty,  34;  sixty  and 
seventy,  6;  over  seventy,  1.  Since  going  into  operation,  this  asylum  has  re- 
ceived two  hundred  and  eight  applications  for  admission,  which  were  necessarily 
refused  for  want  of  room,  or  because  the  patient  was  a  non-resident  of  the  state. 

In  the  able  and  interesting  report  before  us.  Dr.  Awl  urges  the  importance  of 
extending  the  accommodations  of  the  asylum,  so  as  more  nearly  to  supply  the 
wants  of  the  community; — exhibits,  by  contrasting  the  expenses  of  chronic  and  of 
acute  cases,  the  pecuniary  advantage  of  early  treatment;  reports  several  interest- 
ing cases  which  have  been  under  his  care,  and  makes  some  valuable  remarks 
upon  the  causes  of  insanity,  the  value  of  labour  and  of  religious  services  in  its 
treatment,  and  upon  other  topics  connected  with  the  general  subject. 

6.  By  the  ample  report  of  Dr.  Stribling,  it  appears  that  the  VV^estern  Lunatic 


140  Bibliographical  Notices,  U^^Y 

Asylum,  of  Virginia,  is  in  a  very  prosperous  condition.  During  the  past  year, 
an  additional  edifice,  for  the  accommodation  of  sixty  patients,  has  been  erected. 
The  necessity  of  this  is  demonstrated  by  the  fact,  that  there  have  been  180  appli- 
cants for  that  department  alone.  The  asylum  can  now  accommodate  100  men 
and  41  women.  The  number  of  patients  at  the  beginning  of  the  year,  was  69; 
admitted  daring  the  year,  53;  total,  123.  Discharged  recovered,  15;  eloped,  1; 
died,  6;  remaining,  100.  Two  had  recovered  who  had  still  remained  in  the 
asylum.  "  Our  list  of  discharges,"  says  Dr.  S.,  "  must  be  restricted  almost  ex- 
clusively to  those  who  may  recover,  elope  or  die.  By  far  the  greater  number 
of  our  patients  are  paupers,  who  were  brought  here  in  the  chronic  stage  of  insa- 
nity; and  we  are  compelled  by  law,  to  keep  them  during  life,  or  until  cured." 

From  July  1,  1836,  to  November  1,  1841,  the  number  of  admissions  was  131; 
of  cures,  51;  and  of  deaths,  21.  From  1828  to  1841,  inclusive,  the  average 
annual  number  of  patients  was  60;  that  of  deaths,  3;  mean  per  centum  of  deaths, 
5.  The  report  under  notice  contains  an  account  of  the  present  condition  of  many 
of  the  lunatics  of  Virginia,  who  have  never  enjoyed  the  benefits  of  a  public  in- 
stitution. In  this,  the  same  fearful  picture  of  misery  and  suffering,  of  imprison- 
ment, manacles  and  chains,  which  has  heretofore  been  depicted  in  other  states, 
is  again  brought  before  the  view,  in  all  its  hideous  deformity. 

7.  Heretofore,  it  has  not  been  customary  for  the  officers  of  the  Eastern  Luna- 
tie  Asylum,  at  Staunton,  Virginia,  to  publish  an  annual  report,  and  the  one  now 
before  us  we  suppose  to  be  the  first  of  a  prospective  series.  We  trust  that,  here- 
after, the  octavo  or  large  duodecimo  form  will  be  adopted  in  preference  to  the 
quarto,  that  in  which  this  is  printed.  Aside  from  the  greater  convenience  to  the 
reader,  those  smaller  forms  are  generally  adopted  by  other  institutions,  and,  by 
establishing  a  uniformity  in  this  respect,  those  who  preserve  these  pamphlets  are 
enabled  to  have  them  bound  up  together.  On  the  1st  of  July,  1841,  Dr.  Joha 
M.  Gait  assumed  the  duties  of  superintendent  of  this  asylum.  At  that  time  it 
contained  109  patients,  of  whom  68  were  men,  and  41  women.  A  large  majority 
of  them  were  incurable.  From  the  1st  of  July  to  the  31st  of  December,  of  the 
same  year,  14  were  admitted,  11  discharged,  and  15  died.  Of  the  11  discharged, 
9  were  cured,  and  one  so  far  improved  as  to  recover  in  a  short  time  afterwards. 
In  this  report,  Dr.  Gait  recommends  several  judicious  innovations,  and  evident 
improvements  in  the  organization  and  discipline  of  the  asylum.  It  is  with  plea- 
sure that  we  perceive  this  institution  adopting  the  modern  improvements,  and 
commencing  that  intercourse  with  the  community  and  with  other  asylums,  which 
can  be  effected  through  the  medium  of  reports  alone. 

8.  The  annual  reports  of  the  public  institutions  of  the  United  States,  have 
acted  as  powerful  instruments  in  awakening  public  sentiment  in  favour  of  the 
Insane.  This  increasing  interest  has  entered  the  ranks  of  the  Medical  profes- 
sion, and  is  manifested  by  the  greater  attention  devoted  by  writers,  to  the  sub- 
ject. We  have  two  pamphlets  which  have  recently  appeared,  that  of  Dr. 
Coventry,  and  that  of  Dr.  Jarvis.  Dr.  Coventry,  in  his  lecture  before  the 
Young  Men's  Association  of  Utica,  does  not,  we  presume,  profess  to  throw 
any  new  light  upon  the  subject,  but  rather,  by  condensing  into  the  narrow  com- 
pass of  a  lecture,  as  great  an  amount  as  possible,  of  truths  with  which  we  are 
already  familiar,  to  illuminate  minds  hitherto  unenlightened  in  regard  to  the  dis- 
ease. He  treats  upon  the  causes,  symptoms,  pathology  and  treatment  of  insa- 
nity, the  location,  construction  and  organization  of  asylums,  and  subsequently, 
gives  the  statistics  of  the  disease  in  the  state  of  New  York,  followed  by  a  his- 
tory of  the  asylum  at  Utica.  According  to  his  exposition,  even  after  the  pre- 
sent building,  which  will  accommodate  from  250  to  300,  shall  be  filled,  there  will 
be  1555  lunatics  and  idiots  in  the  state,  unprovided  for  by  the  public  institu- 
tions. 

The  prevailing  doctrine  of  the  pathology  of  the  disease  is  given  in  the  lan- 
guage of  Dr.  Bottex.  In  this  generally  valuable  lecture  of  Dr.  C,  there  are, 
in  a  few  instances,  assertions  of  a  somewhat  too  sweeping  or  exclusive  a  cha- 
racter. Of  this  kind  is  the  following:  "./?//  the  modern  writers  on  insanity 
consider  it  a  disease  of  the  brain;  at  first  functional,  but,  if  it  permitted  to  go  on, 


1842.]  Beports  of  Insane  Hospitals.  141 

producing  changes  in  the  organization  of  this  organ,  in  which  state  the  disease 
is  generally  incurable."  From  this  assertion  we  must  except  Leuret  and  some 
of  the  German  authors.  Without  assuming  the  prerogative  of  philological  cri- 
ticism, we  may  venture  to  express  a  doubt  whether  the  following  sentence  con- 
veys the  idea  intended  by  the  writer.  "  In  the  McLean  Asylum,  patients  fre- 
quently have  an  attendant^  whose  whole  attention  is  devoted  to  himself  ^  There  are 
many  attendants  who  would  rejoice  in  a  possession  of  a  situation  of  that  kind! 

9.  A  few  months  since.  Dr.  Edward  Jarvis,  of  Louisville,  Kentucky,  publish- 
ed an  essay  on  insanity,  and  Insane  Asylums,  of  which  a  bibliographical  notice 
appeared  in  the  last  number  of  this  Journal.  More  recently,  the  author  has 
published  a  pamphlet  entitled,  "  What  shall  we  do  with  the  Insane  of  the 
Western  country."  The  object  of  this,  as  may  be  inferred  from  the  title,  is  to 
awaken  the  attention  of  our  Western  neighbours,  and  bring  them  to  a  decision 
upon  "what  shall  be  done  with  the  four  thousand  four  hundred  and  forty-one 
lunatics  and  idiots  that  live  in  the  valleys  of  the  Ohio  and  the  Mississippi."  In 
pursuance  of  this  object,  Dr.  J.  examined  the  condition  of  those  insane  and 
idiots  in  reference  to  their  curability.  He  then  demonstrates  the  utility  of  re- 
moving them  from  their  houses,  supporting  the  proposition  by  quotations  from 
several  authors.  Having  discussed  the  merits  of  confinement  in  prisons,  of 
travel,  and  of  boarding  in  private  families,  and  shown  the  first  to  be  "  worse 
than  useless,"  and  the  last  two  to  be  ineffective  in  a  great  majority  of  cases,  he 
arrives  at  the  conclusion  that  "  the  Hospital"  is  the  most  appropriate  resort,  and 
furnishes  the  most  effective  means  for  treatment.  The  progress  of  asylums  for 
the  insane  is  traced,  and,  in  connection  with  the  question,  how  far  the  existing 
institutions  can  be  available  for  the  lunatics  of  the  West,  most  of  those  institu- 
tions are  described.  From  this  description  we  extract  the  following,  inasmuch 
as  it  will  explain  the  unsatisfactory  results  of  treatment  in  the  asylum  of  which 
it  speaks. 

"  The  Kentucky  Lunatic  Asylum  was  established  before  the  late  discoveries 
had  shown  how  far  this  disease  is  controllable  by  attention,  skill,  and  most  faith- 
ful and  tender  watchfulness,  in  conjunction  with  variety  of  occupation.  The 
original  plan  did  not  include  a  physician  exclusively  devoted  to  the  institution; 
nor  workshops,  nor  riding,  nor  reading,  nor  a  great  variety  of  attendants.  Nor 
was  labour  at  first  designed  as  one  of  the  great  means  of  improvement.  A  chap- 
lain and  religious  worship  were  not  then  considered  necessary  for  such  an  insti- 
tution. A  physician  is  engaged  to  visit  the  asylum  once  a  day;  but  his  pay  for 
this  is  so  small  that  he  cannot  neglect  his  general  practice  to  spend  much  time 
among  the  lunatics.  A  few  attendants  are  employed,  rather  to  guard  and  wait 
upon  the  patients,  than  to  be  their  companions,  to  guide  their  thoughts  and  con- 
trol their  feelings.  Since  the  establishment  of  this  asylum,  the  state  has  not 
altered  the  original  plan,  nor  provided  officers,  attendants  and  means  according 
to  the  spirit  of  this  improved  age.  But  an  effort  is  now  making  in  the  legisla- 
ture to  obtain  such  farther  grants  and  privileges  from  the  state,  as  will  place  this 
institution  on  as  good  a  foundation  as  the  best  in  the  United  States." 

In  a  note  appended  to  the  essay,  the  author  remarks,  "  We  are  informed  that 
there  is  no  doubt  that  the  legislature  will  grant  to  this  asylum  all  the  facilities 
that  its  warmest  friends  desire — a  well-paid  physician,  a  sufficient  corps  of  atten- 
dants, and  lands  and  shops  for  the  occupation  of  the  patients." 

After  this  review  of  asylums.  Dr.  J.  proceeds:  "From  this  examination,  we 
are  led  to  the  melancholy  confession  of  the  w^ant  of  due  provision  for  the  com- 
fort and  the  cure  of  the  insane  sufferers  of  the  western  country.  In  this  broad 
and  rich  valley,  from  the  Lakes  to  the  Gulf  of  Mexico—from  the  Alleghanies  to 
the  Rocky  Mountains,  embracing  a  sane  population  of  five  millions,  and  lunatic 
population  of  more  than  four  thousand,  with  no  deficiency  of  wealth,  skill,  or 
benevolence,  we  have  but  four  asylums  for  the  insane.  And  these  could  not 
contain  a  tithe  of  all  who  might  be  subjected  to  their  influence,  and  not  a  fourth 
of  those  who  could  be  benefited  by  them.  We  ought  to  have  public  asylums 
in  Indiana,  Illinois,  Missouri,  Arkansas  and  Mississippi.  And,  besides  these, 
we  want  another  asylum  in  the  West,  one  of  more  elegant  accommodations  than 


142  Bibliographical  Notices.  [J"ly 

ought  to  be  expected  in  any  state  institution; — a  hospital  to  be  planned  and  con- 
structed, furnished  and  administered,  according  to  the  best  ideas  of  the  present 
age." 

The  author  describes  what  this  asylum  should  be  in  its  construction  and  or- 
ganization, giving  the  opinions  of  various  authors  in  regard  to  the  most  suitable 
plans  for  buildings  of  the  kind.  This  vi^ell  written  essay  of  Dr.  Jarvis,  in  con- 
nection with  the  preceding  one  by  the  same  author,  both  exhibiting  profundity  of 
research  and  extensive  reflection  upon  the  subjects  discussed,  is  admirably  calcu- 
lated to  effect  the  benevolent  object  which  stimulated  the  writer  to  its  composi- 
tion. 

10.  By  the  following  extract  from  the  report  of  Dr.  Rockwell,  it  will  appear 
that  the  Vermont  State  Asylum  has  been  enlarged.  "  We  rejoice  in  the  en- 
largement of  our  building  the  past  season.  We  have  suffered  for  the  want  of 
sufficient  accommodations.  Our  prospects  are  now  fair  that  we  shall  be  able 
to  receive  all  who  may  apply  for  admission." 

The  number  of  patients  in  this  asylum  at  the  beginning  of  the  year  was  81. 
Admitted  during  the  year,  84;  discharged,  70;  remaining  at  the  end  of  the  year, 
95.  Of  the  70  discharged,  35  M^ere  recent  cases,  of  which  31  recovered,  and  1 
died;  and  35  were  chronic,  of  which  10  recovered,  and  3  died.  During  the  five 
years  that  the  asylum  has  been  in  operation,  323  patients  have  been  admitted, 
and  228  discharged.    The  whole  number  of  recoveries  is  138,  and  of  deaths,  15. 

1 1 .  New  York,  an  Amazon  among  the  sister  states  in  regard  to  extent  and  popu- 
lation, proved  herself,  years  since,  to  be  equally  majestic  in  regard  to  internal 
improvements,  and  still  preserves  the  characteristic  in  her  noble  efforts  for  the 
relief  of  her  suffering  insane.  The  State  Pauper  Lunatic  Asylum  at  Utica,  pro- 
jected a  few  years  since,  and  its  front  building  now  nearly  finished,  will  accom- 
modate, when  completed,  one  thousand  patients.  No  British  Asylum  is  calcula- 
ted for  so  great  a  number;  the  largest,  that  of  Hanwell,  having  rooms  for  about 
nine  hundred;  and  of  the  continental  institutions,  Salpetriere  alone,  unless,  per- 
haps, we  may  include  Bicetre,  is  equally  commodious. 

In  May,  1841,  the  legislature  of  New  York  authorized  the  appointment  of  a 
Board  of  Trustees,  a  subordinate  committee  of  which  should  be  required  to  visit 
asylums  for  the  insane  in  New  York  and  other  states,  "  inquire  into  their  go- 
vernment, organization  and  internal  arrangements,  and  submit  to  the  legislature 
a  system  for  the  government,  discipline  and  management  of  the  State  Lunatic 
Asylum."  The  Report  of  the  committee  appointed  in  pursuance  of  this  act,  is 
now  before  us — the  giant  of  its  genus,  as  is  the  institution  to  which  it  relates. 
With  its  appended  documents,  it  forms  an  octavo  volume  of  233  pages.  The 
committee  give  a  succinct  sketch  of  the  history  of  insanity,  and  an  outline  of 
the  modern  mode  of  treatment;  discuss  the  question  of  what  classes  of  patients 
should  be  received  into  the  asylum  at  Utica,  and  some  other  topics  in  connection 
with  the  subject.  After  speaking  of  the  important  duties  devolving  upon  the 
superintendent  of  such  an  institution,  they  proceed  as  follows: 

*'  Where  is  the  individual  whose  high  and  varied  qualifications,  moral,  intel- 
lectual and  physical,  in  rare  but  indispensable  combination,  fit  him  for  such  mul- 
tifarious duties?  To  whom  is  such  a  sacred  and  momentous  trust  to  be  confided'? 
To  an  active,  charitable,  conscientious  man  of  good  sense  and  mild  manners, 
with  perfect  self-command  and  a  thorough  knowledge  of  human  nature: — to  a 
well-educated  physician,  of  tact,  firmness  and  experience,  familiar  with  the  im- 
proved medical  and  moral  treatment  of  insanity;  to  an  energetic  philanthropist, 
of  calmness  and  decision,  of  moral  and  physical  courage,  who  is  never  weary  of 
doing  good,  whose  benevolence  can  make  the  lunatic  a  companion  and  friend,  in 
all  the  essential  qualities  of  reciprocal  confidence,  mutual  forbearance,  fellow- 
feeling  and  rational  counsel,  and  whose  refined  sense  of  duty  'guides  even 
kindness  and  affection  in  their  ministrations,  and  holds  the  balance  as  scrupu- 
lously in  deciding  on  the  moral  rights  of  the  insane,  as  on  the  civil  rights  of 
other  citizens.'  That  such  a  person  can  be  found,  the  trustees  confidently  be- 
'  lieve." 

Whether  Dr.   Woodward,   of  the   Massachusetts   State   Lunatic   Hospital, 


1842.]  Pharmacopoeia  of  the  United  States.  143 

was  before  the  "  mind's  eye"  of  the  writer  of  this  extract,  we  do  not  know,  but 
we  more  than  half  suspect  it  to  have  been  the  case,  as  well  from  the  likeness  of 
the  picture  as  from  the  fact  that  the  gentleman  in  question  has  received  the  ap- 
pointment to  the  place  referred  to. 

The  report  contains  a  system  of  rules  and  regulations  for  the  asylum  at 
Utica — a  table  of  the  insane  of  the  United  States,  according  to  the  late  census — 
similar  tables  of  the  insane  of  the  State  of  New  York,  by  counties,  according 
to  both  the  national  and  the  state  census — a  statement  of  the  number  of  lunatic 
paupers  confined  in  jails,  &c.,  at  public  expense,  throughout  the  state — a  speci- 
fication of  the  plan  of  the  asylum  and  estimates  of  the  expense  of  furniture. 
Among  the  appended  documents  are,  a  description  of  the  insane  asylums  in 
actual  operation  in  the  United  States — letters  from  the  superintendents  of  most 
of  those  asylums,  giving  much  general  and  specific  information  in  regard  to 
them — extracts  from  the  published  reports  of  asylums,  from  "a  visit  to  thirteen 
asylums,  in  Europe,"  and  from  the  report  of  the  commissioners  of  the  Massa- 
chusetts State  Lunatic  Hospital — a  sketch  of  the  labours  of  Pinel,  and  an  article 
from  the  Report  of  the  Prison  Discipline  Society,  illustrative  of  "  important 
principles  adopted  by  the  superintendents  of  insane  asylums  in  the  treat- 
ment of  the  insane."  Such  is  a  synopsis  of  the  contents  of  the  publication 
before  us.  Under  these  several  heads  is  found  a  large  portion  of  actual  know- 
ledge of  the  most  judicious  discipline  and  government  of  hospitals  for  the  in- 
sane, the  proper  method  of  treatment,  and  several  other  kindred  or  collateral 
subjects.  It  is  to  be  hoped  that  this  report  will  be  widely  circulated  in  the 
Utiited  States,  since,  should  it  fall  into  judicious  hands,  it  would  act  as  a  power- 
ful stimulus  to  energetic  measures  in  behalf  of  lunatics  in  those  states  which, 
hitherto,  have  taken  no  steps  towards  the  melioration  of  the  condition  of  that 
unfortunate  class.  It  may  serve,  also,  as  a  guide  to  future  commissioners  or 
boards  of  trustees,  rendering  their  labours  comparatively  trifling,  by  present 
ing  to  them,  already  collected,  digested  and  condensed,  a  vast  amount  of  factg 
necessary  to  a  faithful  fulfilment  of  their  duty, 

P.  E. 


Art.  XV. — The  Pharmacopoeia  of  the  United  States  of  America^  hy  authority  of 
the  National  Medical  Convention  held  at  Washington^  A.  D.  1840:  8vo.,  Grigo- 
&  Elliot,  1842. 

The  proceedings  of  the  Convention  for  the  revision  of  the  Pharmacopoeia, 
which  met  in  January  1840,  have  been  placed  before  the  public  through  the 
medium  of  this  and  similar  journals;  it  is  therefore  unnecessary  to  detail  the 
initiatory  steps  taken  to  secure  the  execution  of  the  work  for  which  that  body 
was  organized.  The  only  feasible  plan  was  the  one  adopted — the  appointment 
of  a  committee  to  whom  the  revision  was  entrusted,  and  from  the  hands  of  this 
committee  the  present  revised  edition  has  emanated.  The  delay  in  publication 
has  arisen  from  circumstances  which  rendered  it  expedient  for  the  advantage  of 
the  work,  and  which  were  inseparable  from  the  course  which  the  committee 
were  authorized  to  pursue:  the  whole  ground  of  the  subject  had  not  only  to  be 
gone  over,  but  as  assistance  was  solicited  from  associations  capable  of  render- 
ing it,  a  length  of  time  was  unavoidably  consumed  in  awaiting  their  contribu- 
tions, and  these  again  required  deliberate  consideration.  As  the  sources  whence 
these  contributions  proceeded  are  the  pharmaceiltical  bodies  of  all  the  cities 
where  such  combinations  exist,  namely,  of  New  York,  Boston  and  Philadel- 
phia, and  particularly  as  most  important  aid  was  afforded  by  the  College  of 
Pharmacy  of  the  latter  place,  from  which  an  amendment  of  the  whole  Pharma- 
copoeia, by  a  special  committee,  was  obtained,  the  present  work  possesses  the 
recommendation  of  being  the  production  of  both  the  bodies  interested,  the  medi- 
cal and  pharmaceutical,  and  by  both  should  therefore  be  assumed  as  authority. 

The  general  outlines  adopted  in  the  edition  of  1830  have  been  preserved  in 


144  Bibliographical  Notices.  [J"^y 

the  present;  thus  the  two  great  divisions  into  the  Materia  Medica  and  Prepara- 
tions^ the  subdivisions  of  the  former  into  primary  and  secondary  lists,  the  alpha- 
betical arrangement,  and  general  system  of  nomenclature,  have  been  retained; 
the  alterations  made  involve  details  solely,  and  are  in  accordance  with  the  expe- 
rience that  ten  years  has  communicated,  and  with  the  advance  of  scientific  in- 
formation. 

In  the  materia  medica  lists,  the  changes  that  have  been  deemed  expedient 
are,  the  introduction  of  new  substances  into  one  or  the  other,  as  they  presented 
claims,  founded  upon  their  so  far  ascertained  comparative  merits,  and  the  ejec- 
tion of  others  which  have  been  proved  to  possess  no  determinate  value,  the  ele- 
vation from  the  secondary  to  the  primary  list  of  such  as  have  come  into  more 
general  use,  and  consequently  have  an  increased  importance,  the  degradation 
from  the  primary  to  the  secondary  list  of  those  which  have  been  ascertained  not 
to  be  worthy  the  position  they  held,  and  lastly,  the  removal  from  the  Materia 
Medica  to  the  class  of  Preparations,  of  substances  which  more  properly  belong 
to  this  head.  It  appears  upon  inspecting  the  appended  tables,  that  32  introduced 
medicines  are  named,  19  of  which  belong  to  the  primary  and  13  to  the  secon- 
dary list;  the  number  that  have  been  dismissed  amount  to  7;  the  articles  that 
have  been  transferred  to  the  primary  list  are  calamus,  cimicifuga,  and  lactuca- 
rium;  those  removed  to  the  secondary  are  mucuna  and  iris  florentina;  two  sub- 
stances have  been  placed  among  the  preparations,  acetate  of  potassa  and  ferro- 
cyanuret  of  iron. 

There  is  no  greater  evidence  of  the  improvement  of  modern  pharmacy  than 
that  presented  in  the  character  of  the  additions  which  have  been  made  to  the 
number  of  preparations,  most  of  which  have  arisen  from  the  progressive  perfec- 
tion of  chemical  knowledge,  and  its  happy  adaptation  to  pharmaceutical  pur- 
poses. No  fewer  than  80  have  been  introduced  into  the  present  edition  of  the 
Pharmacopoeia,  which  the  demands  of  medicine  have  required,  and  which  have 
not  only  been  sanctioned  by  their  position  in  European  authoritative  works  of 
the  same  kind,  but  have  been  shown,  by  their  general  employment,  to  have  more 
than  ordinary  pretensions  to  notice — most  of  them  are  essentially  simple,  or  if 
compound,  in  strict  relation  with  the  principles  of  chemical  combination.  The 
most  striking  feature  of  pharmacy  at  the  present  day,  is  its  extreme  simplicity, 
exhibiting  a  vast  difference  in  this  respect  from  the  polypharmacy  of  the  last 
and  preceding  centuries.  A  still  further  enlargement  of  the  catalogue  of  prepa- 
rations might,  we  conceive,  have  been  advantageously  ventured  upon.  Of  the 
27  preparations  dismissed,  several  are,  no  doubt  worthy  the  fate  appointed  them. 
As  this  is  a  point,  however,  about  which  there  is  most  difference  of  opinion,  we 
question  whether  the  repudiation  in  all  instances  will  meet  with  entire  appro- 
bation. 

We  have  long  regarded  the  nomenclature  of  the  U.  S.  Pharmacopoeia  as 
chaste  and  classical,  without  redundancy,  yet  not  meagre,  always  clear  and 
expressive.  Borrowed  as  it  must  be  from  the  tributary  sciences  of  botany,  che- 
mistry, mineralogy  and  zoology,  the  alterations  that  have  been  made  in  it,  have 
originated  from  the  improvements  and  discoveries  engrafted  on  them  by  the  most 
distinguished  savans  of  the  age.  For  an  explanation  of  the  principles  which 
constitute  the  basis  of  the  system  adopted,  with  an  able  and  satisfactory  expo- 
sition of  its  merits,  we  recommend  not  only  the  perusal,  but  the  attentive  study 
of  that  portion  of  the  preface  of  the  edition  of  1830,  appropriated  to  this  topic, 
to  every  physician  and  apothecary.  The  improvements  made  in  it  are  strictly 
in  accordance  with  the  principles  first  laid  down,  and  consist  of  alterations  of 
names  to  those  now  adopted  generally,  or  rendered  expedient  by  their  brevity; 
thus  cetraria  has  been  assumed  for  lichen,  mucuna  for  dolichos,  and  acacia  for 
acaciae  gurnmi,  creta  for  calcis  carbonas,  marmor  for  calcis  carbonas  durus,  &c. 
A  marked  improvement  is  also  evident  in  the  designation  of  the  portion  of  plants 
which  afford  or  yield  medicinal  articles,  as,  for  instance,  in  the  case  of  the  um- 
belliferous plants,  the  "  fruit"  of  which  are  designated  instead  of  the  inaccurate 
expression  "  seeds." 

With  respect  to  what  we  regard  an  improvement  on  the  old  Pharmacopoeia, 


1842.]  Bell  on  Regimen  and  Longevity,  145 

it  will  suffice  to  present  a  quotation  from  the  preface  as  follows: — "  Another 
novel  feature  of  the  present  edition  is  the  introduction,  in  connection  with  cer- 
tain articles  of  the  Materia  Medica  and  certain  preparations,  of  brief  notes  indi- 
cating the  readiest  means  of  ascertaining  their  genuineness  and  purity.  In  this 
improvement  the  example  of  the  London  and  Edinburgh  Colleges,  in  the  late 
edition  of  their  respective  Pharmacopcfiias  have  been  followed,  and  use  has  been 
made  of  the  rules  given  by  these  Colleges,  so  far  as  they  are  deemed  appli- 
cable." 

The  most  decided  characteristic  of  the  new  Pharmacopoeia,  and  that  which 
strikes  one  accustomed  to  the  previous  edition,  is  the  complete  English  garb  in 
which  it  is  put  forth;  this  may  not  please  those  who  are  sticklers  for  an  univer- 
sal language  of  science,  and  whose  ideas  of  medicines  and  medicinal  preparations 
are  clothed  in  antiquated  Latin,  with  its  forced  and  sometimes  ludicrous  corre- 
spondence in  tenses;  but  the  argument  of  the  committee  is  all  sufficient  to  con- 
vince an  unbiassed  and  unprejudiced  mind  of  the  correctness  of  the  step  they 
have  taken,  and  in  fact  it  is  so  pithily  expressed,  as  to  be  unanswerable;  it  is  as 
follows:  "  There  seems  to  be  no  sufficient  practical  advantage  to  counterbalance  the 
inconvenience  of  attempting  to  present  ideas  in  a  language  which  has  no  appropriate 
words  to  express  them^  and  the  labour  and  expense  incurred  in  printing  tivice  as 
much  matter  as  is  necessary  to  convey  the  meaning  intended,''''  With  so  forcible  a 
presentation  of  the  case,  it  is  hardly  necessary  to  extenuate  the  omission  by  plead- 
ing the  precedents  afforded  by  the  French  Codex  and  Edinburgh  Pharmacopoeia. 

The  last  point  of  novelty  we  have  to  notice,  is  the  mode  of  preparation,  to 
which  has  been  given  the  title  of  "method  of  displacement:"  this  has  now 
come  into  such  general  use,  and  is  so  highly  thought  of  by  the  most  skilful 
and  best  qualified  pharmaceutists,  as  to  have  been  almost  entirely  substituted 
by  them  for  the  former  method  by  maceration  and  filtering.  It  requires  consider- 
able practical  tact,  however,  and  considerable  practice  to  adapt  it  to  the  cases 
where  it  can  be  employed,  and  the  committee  have  therefore  given  the  choice 
of  the  two  modes  of  manipulation.  An  outline  of  the  mode  of  conducting  the 
new  method  has  been  judiciously  presented.  The  subject  for  several  years  past 
has  occupied  the  attention  of  pharmaceutists,  and  those  who  should  wish  to 
understand  it  thoroughly  from  details,  we  refer  to  the  pages  of  the  Journal  of  the 
Philadelphia  College  of  Pharmacy, 

We  cannot  close  this  brief  sketch,  without  expressing  the  opinion  that  the 
American  medical  and  pharmaceutical  public  are  under  deep  obligations  to  the 
learned  and  accurate  individuals,  who  for  a  year  and  a  half  have  devoted  them- 
selves to  the  production  of  a  work,  which,  whatever  may  be  its  defects,  and 
however  open  to  criticism  isolated  portions  of  it  may  be,  still  as  a  whole  pre- 
sents a  favourable  evidence  of  the  condition  of  science  in  the  United  States,  and 
which  cannot  but  be  regarded  as  a  monument  of  our  intellectual  condition. 

J.C. 


Art.  XVI. — On  Regimen  and  Longevity;  comprising  Materia  Mimentaria^  Na- 
tional Dietetic  usages,  and  the  influence  of  Civilization  on  Health  and  the  Dura- 
tion of  Life.  By  John  Bell,  M.D.,  &c.  Philadelphia:  Haswell  &  Johnson, 
1842,  12mo.  pp.  420. 

This  interesting  and  instructive  little  volume  recommends  itself  forcibly  to 
the  attention,  not  only  of  the  general  reader,  but  of  the  members  of  the  medical 
profession. 

A  correct  treatise  upon  the  Materia  Alimentaria,  embracing  the  results  of  the 
more  recent  and  accurate  observations  in  relation  to  the  principal  articles  that  are 
employed  for  food,  or  used  as  drinks  by  the  various  nations  of  the  earth,  as  well 
as  those  leading  principles  bearing  upon  the  subject  of  dietetics  generally  that 
have  been  developed  by  a  more  accurate  acquaintance  with  the  physiology  of 
digestion  and  nutrition,  has  been  lono-  called  for.  Merely  to  say  that  such  a 
No.  VII.— July,  1842.  13 


146  Bibliographical  Notices.  [July 

treatise  is  presented  in  the  work  before  us,  would  scarcely  be  doing  strict  justice 
to  the  author,  and  would  certainly  fail  to  convey  to  our  readers  a  correct  idea  of 
its  real  character.  Dr.  Bell  has  embraced  within  the  general  scope  of  the  sub- 
jects of  which  he  treats,  much  curious  and  instructive  matter,  obtained  from 
various  sources  of  somewhat  difficult  access  to  the  general  reader  as  well  as  to 
a  large  portion  of  the  members  of  our  profession. 

"  It  has  been  the  aim  of  the  author,"  as  he  remarks  in  his  preface,  "  to  collect 
and  arrange  more  abundant  and  diversified  material,  in  order  to  guide  his  readers 
to  a  proper  conclusion,  than  are  met  with  in  books  on  regimen.  In  place  of  fix- 
ing attention  on  the  precise  weight  and  measure  of  every  article  of  food  as  it  is 
brought  to  the  table,  and  prescribing  rigidly  the  allov,^ance  to  the  invalid,  he  has 
extended  the  range  of  observation  and  inquiry,  and  showed  how  entire  nations 
have  lived  and  thrived  on  the  very  substance  about  which  there  was  so  much 
medico-culinary  consultation  and  speculation.  He  has  preferred  setting  forth 
the  conditions  and  attainable  means  by  which  communities  are  kept  in  health, 
and  longevity  attained,  to  minute  specifications  of  the  arts  by  which  a  luxurious 
and  pampered  individual  may  compromise  between  his  appetites  and  his  health, 
and  procure  enjoyment,  if  it  were  possible,  without  complying  with  the  laws 
through  which  alone  it  is  procurable.  But  although  the  lesson  be  not  specially 
directed  to  the  invalid,  it  is  so  contrived  as  to  reach  his  wants  and  strengthen 
his  convictions  of  what  is  proper." 

*'An  enlarged  knowledge  such  as  that  furnished  by  a  view  of  national  dietetic 
usages,  and  of  the  wide  geographical  range  and  cultivation  for  food  of  various 
vegetable  substances,  will,  it  is  believed,  serve  to  dispel  certain  prejudices 
against  some  articles,  on  the  regular  and  continued  use  of  which,,  for  a  period  of 
more  or  less  duration,  the  restoration  to  health  of  the  invalid  and  the  sick  will 
greatly  depend,  more  indeed,  than  on  medicines,  however  skilfully  prescribed 
and  punctually  and  aflfectionately  administered.  But  as  already  intimated,  he 
does  not  profess  to  deal  in  specialities;  his  ambition  is  to  influence  the  commu- 
nity at  large,  and  particularly  the  young  and  inquiring,  whose  habits  are  not  yet 
formed.  For  this  purpose,  he  has  placed  before  them  a  series  of  facts  on  the 
dietetic  usages  of  both  ancient  and  modern  nations,  and  on  the  alimentary  value 
and  amount  of  the  substances  used  for  food  in  nearly  all  parts  of  the  inhabited 
globe.  Details  of  this  nature  are  part  of  the  physical  history  of  man,  which, 
ought  to  precede  the  study  of  his  general  or  politico-civil  history." 

"  While  advocating  simplicity,  the  author  also  recommends  variety  in  dietetic 
regimen:  he  thinks  that  meat  should  be  sparingly  used,  but  he  displays  the  end- 
less variety  of  vegetable  food,  and  the  prodigal  supply  of  fruits  with  a  luxu- 
rious enjoyment  in  their  free  use — in  the  state  in  which,  by  a  favouring  climate 
and  skilful  industry,  they  are  met  with  in  nearly  all  parts  of  the  world." 

"  In  sedulously  avoiding  all  needless  technicalities,  the  author  has  been  mind- 
ful of  the  proper  expectations  of  the  general  reader,  while,  at  the  same  time,  he 
has  not  thought  himself  free  to  pass  over  the  explanations  and  illustrations  fur- 
nished by  organic  chemistry,  which  merits  a  better  fate  than  being  thrust  away 
in  the  farthest  corner  of  our  common  works  on  general  chemistry,  or  hurried 
over  as  a  dispensable  appendix  to  a  course  of  public  lectures  on  the  science  at 
large." 

"  The  free  introduction  of  statistical  calculations  into  these  pages  will  often 
give  the  reader  a  clearer  idea  of  the  alimentary  importance  and  commercial 
value  of  certain  substances  used  for  food  than  common  notices  or  even  any 
assertion  of  their  extraordinary  dietetic  value  could  convey." 

These  extracts  from  the  author's  preface  present  a  very  accurate  outline  of  the 
character  of  the  volume  before  us.  In  the  description  of  the  several  articles  of 
the  materia  alimentaria  the  author  has  followed  nearly  the  same  order  with  that 
adopted  by  writers  on  Materia  Medica.  The  original  locality  and  the  countries 
where  the  cerealia,  leguminosas,  and  nutritive  tubers,  and  the  nutritive  and  other 
fruits  flourish;  their  composition  as  respects  proximate  principles,  their  aliment- 
ary value  and  absolute  and  relative  quantities  produced  and  available  for  home 
and  foreign  consumption,  are  duly  noticed.     Subsequently  will  be  found  the 


I 


1842.]  Valleix's  Practitioner's  Guide,  147 

modes  of  preparation  and  combination  of  the  chief  nutritive  grains,  for  common 
use  and  the  wants  of  the  invalid. 

In  conclusion,  we  would  recommend  the  work  to  the  notice  of  our  readers, 
as  one  calculated  to  impart  more  correct  information  as  to  the  actual  dietetic 
value  of  the  various  articles  employed  by  mankind  as  well  for  food  as  drink, 
than  can  be  acquired  from  most  if  not  all  the  treatises  upon  diet  and  regimen 
which  have  preceded  it. 

D.  F.  C. 


Art.  XVII. — Guide  du  medecin  pradicien  ou  resume  general  de  jpathologie  in- 
terne et  de  therapeutique  appliquees. 
The  Practitioner^ s  Guide:  a  Practical  Compendium  of  internal  Pathology  and  The- 
rapeutics. — By  F.  L.  J.  Valleix.     Paris,  1841,  Nos.  1  and  2. 

The  author  has  undertaken  the  present  work  in  the  hope  of  supplying  a  want 
in  medical  literature  which  all  practical  physicians  must  have  experienced.  For 
many  years  past  the  medical  journals  of  every  country  have  been  filled  with 
accounts  of  experiments  in  therapeutics  conducted  with  g^reat  care  and  product- 
ive of  important  results,  but  so  scattered  through  the  records  of  periodical  lite- 
rature, that  few  physicians  have  either  the  time  or  the  patience  to  study  them 
critically,  or  even  to  read  them  at  all.  M.  Valleix  has  undertaken  the  interest- 
ing but  very  laborious  task  of  bringing  together  all  the  information  about  inter- 
nal diseases  and  their  treatment  which  he  could  find  dispersed  throughout 
the  works,  both  large  and  small,  of  all  countries  and  ages;  not  as  a  mere  com- 
piler however,  nor  in  such  a  way  as  to  perplex  his  readers  with  a  long  list  of 
opinions  or  receipts,  but  by  a  critical  examination  of  doctrines  and  precepts,  to 
establish  such  principles  as  are  adapted  to  the  present  state  of  medical  science 
and  art. 

This  work  differs  from  previous  ones  in  the  pains  taken  by  the  author  to  point 
out  the  diagnosis  of  each  affection  in  so  clear  a  manner  as  almost  to  prevent  the 
possibility  of  mistaking  it,  by  placing  in  contrast  upon  opposite  sides  of  the  page 
the  prominent  symptoms  of  diseases  liable  to  be  confounded,  so  that  their  dis- 
tinctive characters  may  be  seen  at  a  glance.  The  excellence  of  this  expedient 
must  recommend  it  to  every  practitioner,  for  although  it  is  not  intended  to  take 
the  place  of  a  more  philosophical  study  of  diagnostic  signs,  but  rather  to  sug- 
gest and  encourage  such  study,  it  refreshes  the  memory  of  the  scientific  man, 
and  gives  method  to  his  knowledge,  while  it  saves  from  the  commission  of  seri- 
ous errors  those  who  are  either  ignorant  of  the  principles  of  medicine,  or  too 
indolent  to  apply  them  to  practice. 

The  therapeutic  department  of  the  work  gives  evidence  of  great  research,  and 
of  sound  judgment  in  appreciating  the  value  of  the  several  modes  of  treating 
each  disease,  whether  they  have  been  submitted  to  the  test  of  experiment,  or 
merely  recommended  by  writers  of  authority.  The  indications  to  be  fulfilled 
are  deduced  from  a  minute  study  of  the  diagnosis  of  the  disease,  and  the  treat- 
ment adapted  to  it  is  clearly  pointed  out,  not  only  in  general  terms,  but  in  a 
detailed  account  of  the  most  efficient  remedies,  and  the  best  mode  of  prescribing 
them.  The  frequent  charge  of  feebleness  urged  against  the  practice  recommend- 
ed in  French  works  of  practical  medicine,  does  not  seem  to  be  applicable  to  that 
enforced  in  the  present  one,  if  we  may  judge  from  the  two  numbers  of  it  before 
us.  These  refer  to  certain  diseases  of  the  nasal  cavities,  viz:  epistaxis,  coryza, 
and  ozaena,  in  their  several  varieties  and  complications;  the  treatment  of  each. 
is  discussed  at  greater  length,  more  methodically,  and,  we  think,  more  satisfac- 
torily than  in  any  English  treatise  with  which  we  are  acquainted.  If  the  suc- 
ceeding essays  correspond  to  these  in  exactness  and  completeness,  practitioners 
will  have  reason  to  thank  M.  Valleix  for  having  assumed  a  task  which  very 
few  could  have  been  found  to  execute  so  skilfully,  and  the  performance  of  which 
was  loudly  called  for  by  the  exigencies  of  medical  art. 

A.  S. 


148  Bibliographical  Notices.  [July 

Art.   XVIII. — Quarterly  Summary  of  the  Transactions  of  the  College  of  Physi' 
dans  of  Philadelphia,     February,  March,  April,  1842,  8vo.  p.  24. 

The  communications  read  to  the  College  the  past  quarter,  consist  of  the  an- 
nual reports  on  the  Diseases  of  Women,  by  Dr.  Warrington;  on  Meteorology  and 
Epidemics,  by  Dr.  Moore;  and  on  the  Diseases  of  Children,  by  Dr.  Condie;  a  case 
of  poisoning  with  laudanum,  by  Dr.  Morris,  and  one  of  extensive  destruction  of 
the  vesico-vaginal  septum,  by  Dr.  Ashmead. 

The  reports  are  interesting,  though  perhaps  less  elaborate,  than  could  be  de- 
sired. 

The  case  of  poisoning  with  laudanum  we  give  in  the  relator's  own  words. 

"  Mrs.  A.  intending  to  administer  a  dose  of  oil  to  her  infant,  four  months  old,  to 
prevent  griping,  attempted  to  add  to  it  two  drops  of  laudanum.  It  escaped  more 
rapidly  than  she  wished  from  the  vial,  but  supposing  from  the  appearance,  there 
might  be  about  three  drops,  she  gave  it  at  a  venture.  The  ch«ild  soon  fell  asleep, 
and  though  it  appeared  nervous  and  twitched  frequently,  she  felt  no  uneasiness 
till  it  was  seized  with  convulsions,  about  three  hours  after  the  dose  had  been 
taken.  I  was  then  sent  for,  and  found  it  with  general  convulsions,  stertorous 
breathing,  hot  skin,  pupils  contracted  to  mere  points — the  stupor  was  so  deep 
that  it  could  not  be  aroused  by  any  efforts  I  could  make.  I  at  once  administered 
a  dose  of  sulphate  of  zinc,  which  I  had  carried  with  me,  and  enema  of  strong 
salt  and  water  hourly,  a  part  of  which  was  retained  without  exciting  the  least 
sensation.  On  examining  the  laudanum  bottle,  I  found  there  were  about  twenty 
drops  remaining  at  the  bottom  of  an  ounce  vial,  the  sides  of  which  were  coated 
with  a  deposit  of  opium;  the  little  fluid  at  the  bottom  being  very  turbid,  and 
containing  many  fragments  of  opium  of  considerable  size.  I  at  once  come  to 
the  conclusion  that  we  had  no  means  of  estimating  the  amount  of  opium  taken. 
In  the  first  place,  the  uncertainty  as  to  the  number  of  drops,  w^as  very  great;  any 
one  who  has  dropped  laudanum  into  castor  oil,  may  have  observed  how  very  de- 
ceptive is  the  appearance  it  presents.  In  addition  to  this  cause  of  uncertainty, 
the  turbid  fluid  was  of  much  greater  strength  than  the  clear  filtered  tincture;  but 
above  all,  the  probability  that  a  portion  of  solid  opium  had  escaped  with  the 
fluid  was  so  great  as  to  amount  almost  to  certainty.  Under  these  circumstances, 
the  stomach  being  little  likely  to  respond  to  the  impression  of  remedies,  I  intro- 
duced a  large  catheter  into  it,  and  injected  a  quantity  of  warm  water.  This  was 
promptly  returned  through  the  lube,  (and  I  may  remark  in  passing,  that  I  have 
before  witnessed  the  same  result,)  so  freely  and  promptly,  that  there  was  no  oc- 
casion for  any  effort  to  draw  it  off  by  the  syringe.  The  water  was  returned 
perfectly  pure;  there  was,  however,  no  mitigation  of  the  symptoms.  In  the 
meanwhile  mustard  cataplasms  had  been  applied  to  the  extremities,  and  iced 
water  repeatedly  dashed  upon  the  head,  but  neither  was  sufficient  to  arouse  the 
child.  On  the  contrary,  the  respiration  became  more  slow — the  skin  cold,  and 
the  consciousness  diminished.  I  had  the  child  placed  in  a  warm  mustard  bath, 
which  excited  one  cry,  the  first  and  only  token  of  sensation  manifested  for  many 
hours.  Dr.  Hodge,  who  had  been  summoned  to  my  aid,  arrived  at  this  juncture. 
The  coldness  of  the  surface  and  tokens  of  prostration  becoming  urgent,  we 
agreed  to  administer  brandy  and  water.  In  the  effort  to  swallow  the  first  tea- 
spoonful,  convulsions  set  in,  whether  caused  or  not  by  some  drops  insinuating 
themselves  into  the  larynx,  it  w^ould  be  difficult  to  say.  Convulsion  after  con- 
vulsion ensued,  destroying  the  power  of  deglutition  entirely.  Fearing,  lest  in 
the  passage  of  the  tube  into  the  stomach  for  the  purpose  of  stimulating  the  child 
by  a  continued  use  of  the  brandy,  the  spasm  might  be  aggravated,  we  threw  a 
table-spoonful  of  brandy  mixed  with  a  cupful  of  warm  water  into  the  rectum. 
The  surface  still  continued  cold;  there  was  not  even  heat  of  the  head;  the  breath- 
ing w^as  much  interrupted — the  face  livid.  A  warm  mustard  bath  was  again 
resorted  to,  but  without  any  effect;  the  child  was  indeed  taken  from  it,  as  we 
thought,  moribund.  The  spasm  increasing  in  violence,  the  action  of  the  heart 
alone  indicated  the  retention  of  life.   While  Dr.  Hodge  was  employing  friction  to 


1842.]      Transactions  of  the  Medical  Society  of  New  York,  149 

the  body,  I  thrust  my  finger  into  the  mouth,  and  found  the  jaw  rigid  and  the  tongue 
thrust  forcibly  backward  and  upward  against  the  palate.  Tt  occurred  to  me  at 
the  moment  that  even  if  an  effort  at  respiration  should  be  made,  all  access  of  air 
to  the  lungs  was  effectually  prevented  by  this  condition  of  the  mouth;  placing, 
therefore,  two  fingers  upon  the  tongue  and  the  thumb  between  the  jaws,  I  held 
it  forcibly  open,  at  the  same  time  requesting  Dr.  Hodge  to  compress  forcibly  the 
chest  and  belly  so  as  to  empty  the  lungs:  this  was  repeated  frequently,  the 
elasticity  of  the  cartilages,  and  the  descent  of  the  diaphragm  causing  air  to  be 
drawn  into  the  lungs.  This  was  repeated  for  at  least  three  minutes,  action  of 
the  heart  only  giving  indication  of  the  presence  of  vital  power.  At  length  a 
long  sigh  was  drawn  and  natural  respiration  re-established.  Still  the  surface 
remained  cold,  and  there  was  no  manifestation  of  a  diminution  of  the  influence  of 
the  opium,  although  between  six  and  seven  hours  had  elapsed  since  its  adminis- 
tration. A  large  sinapism  was  applied  to  the  anterior  part  of  the  body,  which 
speedily  induced  redness,  but  without  exciting  the  sensibility  of  the  patient.  It 
was  then  removed  to  the  back  without  any  more  favourable  result.  Cold  air 
was  blown  upon  the  face  repeatedly  with  equal  want  of  success.  The  mustard 
failing  to  excite  permanent  warmth,  at  the  suggestion  of  Dr.  Hodge,  linen 
cloths  were  heated  at  the  fire  and  applied  so  hot,  that  it  was  with  difficulty  they 
could  be  retained  in  the  hands:  by  this  means  an  artificial  heat  was  communi- 
cated to  the  skin  and  the  congestion  of  the  great  vessels  relieved,  the  body  soon 
becoming  red  as  though  covered  with  a  vivid  eruption.  Before  this  was  finally 
effected,  convulsions  again  occurred,  producing  the  same  suspension  of  the  re- 
spiration, and  coldness  and  lividity  of  the  surface,  and  this  time  there  was  no 
perceptible  action  of  the  heart.  We  all  thought  the  child  dead.  The  same  pro- 
cess was  again  resorted  to  for  the  purpose  of  inflating  the  lungs,  with  the  addi- 
tion of  blowing  into  the  throat  whilst  held  open.  So  satisfied  was  I  that  the 
case  was  past  recovery  that  I  should  have  abandoned  it  as  hopeless,  but  the 
active  and  untiring  zeal  of  Dr.  Hodge  was  not  so  easily  subdued,  and  we  per- 
severed again,  and  were  both  astonished  and  delighted  to  witness  the  re- 
establishment  of  natural  respiration.  For  several  hours  we  persevered  in  the 
application  of  the  hot  linen  cloths — certainly  the  most  effectual  way  of  imparting 
heat  to  the  body — and  at  ten  o'clock  at  night,  just  eleven  hours  after  the  dose  had 
been  given,  we  left  the  child  crying  heartily  for  drink,  and  by  the  next  morning 
it  had  entirely  recovered  from  all  the  consequences  of  the  dose." 

Dr.  Ashmead's  case  of  destruction  of  vesico-vaginal  septum  was  so  extremely 
extensive,  that  all  attempts  at  remedying  it  have  proved  unsuccessful. 


Art.  XIX. — Transactions  of  the  Medical  Society  of  the  State  of  New  York.     Vol. 

V.  Part  II. 

This  part  of  the  Transactions  contains  the  Annual  Address,  by  Dr.  J.  B.  Beck; 
a  Review  of  Marshall  Hall's  views  of  an  excito-motory  system  of  Nerves,  by  Dr. 
Nr  S.  Davis;  and  Observations  on  the  signs  of  live  and  still  birth,  by  Dr.  J.  B. 
Beck;  and  an  abstract  of  the  proceedingrs  of  the  society  at  its  annual  session, 
Feb.  1842.  . 

The  annual  address  is  devoted  to  a  history  of  American  medicine  before  the 
Revolution,  considered  under  three  divisions — medical  practice,  medical  litera- 
ture, and  medical  institutions.  This  is  an  extremely  interesting  paper,  but  not 
admitting  of  analysis,  and  it  is  too  long  to  be  transferred  to  our  pages.  We  hope 
that  it  will  be  extensively  circulated;  we  are  sure  that  it  will  be  read  with  plea- 
sure and  profit. 

The  observations  on  live  and  still  birth  are  also  interesting,  and  of  great  im- 
portance in  their  application  to  medical  jurisprudence.  We  shall  give  them  in 
full  in  our  department  of  American  Intelligence. 

13*° 


]50 


Bibliographical  Notices, 


[July 


Art.  X.'K.'— Annual  Report  of  the  Surgeon  General  of  the  United  States  Army, 

From  this  report  we  glean  the  following  particulars. 

The  whole  number  of  cases  of  sickness  during  the  year  ending  30th  Septem- 
ber 1841,  was  38,559,  of  which  number  37,499  occurred  within  the  year,  and 
the  rest  were  remaining  from  the  preceding  one. 

Of  the  whole  number  reported  sick,  36,374  have  been  restored  to  duty;  320 
have  been  discharged  the  service;  30  have  deserted,  and  388  have  died. 

The  mean  strength  of  the  army,  according  to  the  medical  returns,  having  been 
9,748;  the  proportion  of  cases  to  men  in  service  was  396  per  cent.,  or  nearly  4 
to  1.  The  aggregate  of  deaths  was  1  to  25^,  or  nearly  4  per  cent.;  and  the  pro- 
portion of  deaths  to  the  number  of  cases  treated  1  to  99f,  or  a  fraction  more 
than  1  per  cent. 

"  Besides  the  diseases  incident  to  the  climate  and  service  of  Florida,"  it  is 
remarked,  "the  epidemic  fever,  which  has  proved  so  fatal  at  the  'South  during 
the  past  season,  has  also  prevailed  among  the  troops  serving  in  the  territory. 
The  average  strength  of  the  army  in  Florida  during  the  year,  being  about  4,738, 
the  number  of  cases  of  sickness  amounted  to  21,027,  exhibiting  a  proportion  of 
cases  to  the  number  of  officers  and  men  of  nearly  4|  to  1,  or  443  per  cent.  The 
deaths  being  254,  presents  a  ratio  of  mortality  to  the  number  of  men  1  to  18|,  or 
b\  per  cent.;  and  the  proportion  of  deaths  to  the  number  of  cases  treated  of  1  to 
82|,  or  \\  per  cent.  Oi  fourteen  candidates  examined  for  admission  into  the 
army  as  assistant  surgeons,  six  only  were  approved. 

The  following  table  exhibits  the  prevalent  diseases,  the  mortality  from 
each,  &c. 


No. 

Mortality. 

No. 

Mortality. 

Febris  quot.  inter. 

4,843 

5 

Asthma 

24 

0 

do.    tert.      do. 

4,427 

2 

Laryngitis 

26 

0 

do.    quart,   do. 

157 

21(cong 

.)  Cynanche  parotid. 

33 

0 

do.    remittens 

2,509 

43 

Meningitis  and  phrenitis  7 

2 

do.    cont.  com. 

310 

2 

Apoplexia 

10 

7 

do.    typhus 

47 

10 

Paralysis 

12 

0 

do.    icterodes 

29 

6 

Epilepsy 

112 

0 

Vaccinia 

12 

0 

Chorea 

3 

0 

Rubeola 

31 

0 

Tetanus 

1 

1 

Scarlatina 

2 

0 

Mania 

29 

1 

Erysipelas 

50 

1 

Delirium  tremens 

150 

3 

Cynanche  Tracheal. 

17 

0 

Neuralgia 

40 

0 

Tonsilitis 

251 

0 

Cephalalgia 

568 

0 

Dyspepsia 

152 

0 

Nyctalopia 

41 

0 

Colica 

415 

0 

Nephritis 

8 

1 

Haematemesis 

2 

0 

Cystitis 

1 

0 

Gastritis 

113 

1 

Ischuria  and  Dysuria 

25 

0 

Peritonitis 

15 

5 

Eneurisis 

17 

0 

do.           acuta 

7 

2 

Diabetes 

1 

0 

Dysenteria  acuta 

2,834 

38 

Calculus 

1 

0 

do.           chronica 

391 

55 

Syphilis  primitiva 

121 

0 

Diarrhcsa 

3,474 

44 

do.       consecutiva 

61 

1 

Obstipatio 

1,062 

1 

Ulcus  penis  non  syph 

6 

0 

Cholera  Morbus 

210 

1 

Gonorrhoea 

421 

0 

Hepatitis  acuta 

27 

0 

Orchitis 

89 

0 

do.        chronica 

23 

1 

Strictura  urethra 

13 

0 

Icterus 

47 

0 

Anasarca 

39 

3 

Catarrhus 

2,778 

3 

Ascites 

20 

2 

Bronchitis  acuta 

119 

7 

Hydrothorax 

2 

4 

Pleuritis 

210 

4 

Hydrocele 

2 

0 

Pneumonia 

139 

12 

Hypertrophy  of  heart 

3 

1 

Haemoptysis 

29 

3 

Rheumat.  acuta 

700 

0 

Phthisis  pulraonalis 

64 

38 

do.         chronica 

446 

3 

1842.] 


Andral  on  the  Blood  in  Diseases, 


151 


No. 

Mortality. 

No. 

Mortality. 

Podagra 

5 

1 

Prolapsus  ani 

5 

0 

Pernio 

135 

1 

Vermes 

16 

0 

Phlegmon  and  abscess  938 

3 

Scrofula 

19 

0 

Paronychia    , 

98 

0 

Scorbutus 

104 

3 

Fistula 

16 

0 

Cachexia 

21 

0 

Ulcus 

531 

0 

Debilitas 

376 

0 

Ambustio 

137 

1 

Varix 

7 

0 

Vulnus  incisurn 

752 

2 

Tumores 

82 

0 

do.     punctum 

97 

0 

Hernia 

81 

0 

do.     sclopelicum 

108 

14 

Exostosis 

7 

0 

Contusio 

1,167 

3 

Necrosis 

5 

0 

Sub-luxatio 

.     387 

0 

Atrophia 

1 

0 

Luxatio 

31 

0 

Amputatio 

8 

0 

Fractura 

69 

0 

Serpentis  morsus 

7 

0 

Concussio  cerebri* 

3 

0 

Punitio 

32 

0 

Pericarditis 

2 

1 

Intemperance 

125 

9 

Aneurisma 

1 

0 

Morbi  cutis 

181 

0 

Ophthalmia 

859 

1 

Morbi  Varii                 2,964 

8 

Amaurosis 

6 

0 

Cause  not  reported 

Otitis 

95 

0 

Dry  gangrene 

Splenitis 

28 

0 

Intus.  susceptic 

( 

Epistaxis 

5 

0 

Marasmus 

Hemorrhois 

160 

1 

Hydrocephalus 

Art.  XXI.— On  the 

Physical  Alterations  of  the  Blood  andJlnima 

dfluic 

Is  in  disec 

By  M.  Andral.     {Frov.  Med.  and  Surg.  Journ.) 

In  our  preceding  number  we  commenced  an  analysis  of  these  lectures,  and 
we  shall  now  proceed  with  the  task. 

M.  Andral  recognises  the  two  divisions  of  fevers,  idiopathic  and  symptomatic, 
and  states  that  the  former  may  exist,  1st,  without  any  lesion  of  the  solids;  2d, 
with  an  evident  lesion,  but  one  which  is  not  the  cause  of  the  disevise,  and  in- 
stances as  an  example  of  this  last,  the  ulceration  of  the  intestinal  glands  in 
typhoid  fever,  which,  he  states,  are  the  effects  of  some  cause  v;^ith  which  he  is 
unacquainted. 

The  following,  according  to  M.  Andral,  are  the  states  of  the  blood  in  fever. 

"  1st.  If  the  fever  be  symptomatic  of  inflammation,  the  quantity  of  fibrin  is 
augmented;  but  this  increase  does  not  depend  on  the  fever,  for  there  are  several 
fevers,  just  as  intense  and  long  continued  as  the  inflammatory,  in  which  we  ob- 
serve no  increase  of  fibrin;  the  cause  of  the  increased  quantity  of  fibrin  is  not 
easily  discovered,  and  to  assign  any  particular  one,  in  the  present  state  of  our 
knowledge,  would  be  hasty. 

"2d.  When  the  fever  does  not  depend  on  inflammation,  we  have  no  aug- 
mentation of  fibrin,  be  it  ever  so  severe  or  prolonged. 

"3d.  Should  simple  fever  become  complicated,  during  its  course,  with  any 
inflammatory  affection,  then  the  fibrin  increases. 

"  4th.  Fever  and  inflammation  may  co-exist,  the  latter  being  an  essential  ele- 
ment of  the  former,  as  inflammation  of  the  skin  in  small-pox,  measles,  scarlatina, 
&;c.;  these  affections  of  the  skin,  which  perhaps  should  not  be  ranged  under 
inflammations,  are  unattended  with  the  characteristic  increase  of  fibrin;  the  same 
remark  applies  to  ulceration  of  the  intestines  in  typhoid  fever;  however  tena- 
ciously some  physicians  may  adhere  to  the  inflammatory  doctrine  of  typhoid 
fever,  it  is  certain  that  the  ulcerations  of  the  intestinal  glands  are  not  accompa- 
nied by  that  increase  of  fibrin  which  attends  other  inflammatory  diseases.  Hence, 
whenever  fever  co-exists  with  inflammation,  and  together  with  it  constitutes 
one  of  the  elements  of  the  disease,  the  fibrin  of  the  blood  is  not  increased;  for 


152  Bibliographical  Notices*  [July 

example,  small-pox,  typhoid  fever,  &c.  But  it  is  far  different  when  inflamma- 
tion spring's  up  during  the  course  of  the  fever,  or  is  one  of  its  effects." 

The  chief  cause  of  a  certain  class  of  fevers  seems  to  be,  Mr.  A.  conceives,  an 
excessive  richness  of  the  blood.  "Inflammatory  fevers,"  he  says,  "of  a  few 
days'  duration,  depend  upon  this  cause;  the  ancients  considered  this  as  an  idio- 
pathic fever,  but  it  is  really  a  symptomatic  one.  But  we  may  ask,  does  the  cause 
of  the  disease  reside  in  the  solids,  or  in  the  fluids'?  To  excessive  richness  of  the 
blood,  as  just  mentioned,  the  disease  has  been  attributed,  but  this  richness  con- 
sists in  an  increase  of  the  globules,  not  of  the  fibrin.  When  Pinel  published  his 
nosography,  the  humours  were  altogether  neglected,  yet  he  located  inflammatory 
fever  in  the  blood-vessels;  at  a  later  period,  it  was  connected  with  gastritis  and 
enteritis;  afterwards  with  inflammation  of  the  heart  and  arteries;  Tomasini  still 
adheres  to  the  latter  opinion.  It  has  also  been  denominated  plethoric  or  hy- 
peraemic  fever,  in  conformity  with  the  ideas  of  humoral  pathology. 

"  However,  this  is  not  the  only  fever  in  which  the  globules  are  augmented; 
the  same  increase  occurs  at  the  commencement  of  typhoid  fever,  measles,  and 
scarlatina.  We  do  not  find  this  augmentation  of  globules  in  inflammation;  it 
exists  in  the  middle  period  of  fevers. 

"  In  continued  fevers,  the  febrile  movement  persists  even  when  the  globules 
have  fallen  to  their  normal  standard,  or  below  it;  as  a  remarkable  illustration, 
M.  Andral  cites  chlorosis,  in  which  the  quickness  of  the  pulse  augments  in  pro- 
portion to  the  diminution  of  the  globules  and  progress  of  the  disease;  febrile 
symptoms  now  appear,  the  skin  gets  hot,  the  pulse  excessively  frequent,  and 
the  patient  dies.  After  death,  we  find  no  very  evident  traces  of  disease  in  the 
viscera. 

"Fever  may  exist  with  every  possible  condition  of  the  globules,  (normal 
state,  increase,  diminution;)  we  may  admit,  although  we  cannot  prove  it  clearly, 
that  some  fevers  depend  on  increased  richness  of  the  blood;  others,  again,  exist 
with  a  remarkable  diminution  of  the  globules;  in  a  third  class  the  fever  persists, 
although  the  globules  have  been  diminished  by  bleeding  and  abstinence. 

"  If  we  now  examine,  in  a  comparative  way,  the  condition  of  the  various  ele- 
ments of  the  blood  during  fever,  we  shall  find  that  the  simple  presence  of  fever 
never  determines  an  increase  in  the  quantity  of  fibrin;  that  fever  may  exist,  1st, 
when  both  fibrin  and  globules  are  in  normal  quantity;  2d,  when  the  globules 
alone  are  increased,  the  fibrin  remaining  unchanged.  The  quantity  of  fibrin 
may  fall,  during  typhoid  fever,  even  so  low  as  0.9;  at  an  early  stage  of  the  dis- 
ease, or  when  it  is  mild,  the  fibrin  remains  unchanged,  but  falls  as  the  fever  is 
aggravated;  when  it  assumes  an  ataxic  character,  and  symptoms  of  prostration 
ensue  about  the  fifteenth  day,  the  fibrin  also  falls,  and  hence  we  might  be  in- 
clined to  think  that  its  diminution  depended  on  the  duration  of  the  disease;  but 
this  is  not  the  case,  for  in  acute  inflammation  the  quantity  of  fibrin  is  increased, 
even  at  an  advanced  period,  and  in  spite  of  bleeding  and  abstinence  from  food; 
in  fact,  the  condition  of  the  blood  in  typhoid  fever  is  exactly  the  reverse  of  that 
in  inflammation;  in  the  former,  while  the  globules  and  fibrin  are  undergoing  a 
diminution,  the  quantity  of  serum  is  increasing;  hence,  this  is  a  disease  in  which 
the  blood  is  remarkably  impoverished. 

^<'  Physical  formation  of  the  blood  in  fever. — During  fever,  the  separation  of  the 
blood  into  serum  and  clot  is  imperfect,  because  the  latter  is  soft  and  retains  the 
serum.  The  serum,  again,  is  frequently  of  a  reddish  colour,  from  an  admixture 
of  globules,  and  the  clot  is  large;  this  latter  condition  may  depend — 1st,  on  the 
increased  quantity  of  globules  which  frequently  attends  the  development  of 
fever;  2d,  on  the  quantity  of  serum  retained  by  the  clot;  3d,  on  the  diminution 
of  fibrin,  and  consequent  want  of  contractility  in  the  clot.  The  coagulum  may, 
in  many  cases,  preserve  its  usual  degree  of  firmness,  but  the  latter  is  never  in- 
creased; more  frequently  it  is  diminished;  or  the  clot  may  be  quite  soft  and  dif- 
fluent; a  perfect  buffy  coat  never  forms  during  fever,  unless  there  be  inflamma- 
tion; in  typhoid  fever  and  small-pox  we  find  a  thin,  greenish  layer,  which  is  a 
mere  rudiment  of  buflT. 

"  Connection  between  the  state  of  the  blood  and  the  various  symptoms  of  fever, — 


1842.]  Andral  on  the  Blood  in  Diseases.  153 

Fever  may  run  through  its  different  stages  without  presenting  any  complication, 
but  in  other  cases  we  have  a  series  of  phenomena,  which  are,  in  some  measure, 
connected  with  the  febrile  disorder,  though  not  actually  produced  by  it;  these 
are  inflammation,  congestion,  hemorrhage,  and  gangrene. 

Some  inflammations  occur  accidentally,  during  the  course  of  fever,  and  are 
not  attended  with  any  change  in  the  state  of  the  blood;  other  febrile  disorders, 
small-pox,  measles,  &c.,  are  always  accompanied  by  certain  lesions  which  are 
commonly  regarded  as  inflammatory;  but  in  these  also,  the  blood  undergoes  no 
change;  finally,  in  other  fevers  we  have  inflammation  and  its  characteristic  effects 
on  the  blood. 

"  Congestion  is  a  frequent  complication  of  fever,  and  if  we  endeavour  to  trace 
a  connection  between  this  congestion  and  the  state  of  the  blood,  we  are  led  to 
conclude  that  the  former  depends  on  a  loss  of  equilibrium  between  the  fibrin  and 
globules.  The  spleen  and  other  parenchymatous  organs  are  very  often  the  seat 
of  congestion  in  typhoid  and  typhus  fever,  and  in  small-pox;  now  the  alteration 
of  the  blood  observed  in  patients  labouring  under  those  diseases,  is  a  diminution 
in  the  quantity  of  fibrin  as  compared  with  the  globules. 

*'  Hemorrhage,  also,  is  a  frequent  complication  of  fever,  while  it  rarely  occurs 
in  inflammation;  if  we  compare  typhoid  fever  and  pneumonia  together,  this  fact 
will  at  once  strike  us;  the  severity  of  the  hemorrhage,  likewise,  seems  to  follow 
the  violence  of  the  fever,  as  exemplified  in  typhus  fever,  plague,  and  yellow 
fever. 

*'  Gangrene  occurs  less  frequently  than  hemorrhage,  congestion,  or  inflamma- 
tion, but  often  occurs  in  typhus  fever  and  plague;  we  may  also  remark,  that  dis- 
eases accompanied  by  carbuncle,  acute  glanders,  and  the  fever  of  purulent 
absorption,  are  general  febrile  disorders  which  probably  depend  on  alterations 
of  the  blood.  The  ancients  admitted  morbid  conditions  of  the  blood  under  the 
circumstances  just  alluded  to;  they  denominated  "putrid"  that  state  of  the  sys- 
tem in  which  the  vital  force  seemed  to  sink  under  the  influence  of  physical 
changes  and  the  decomposition  of  the  blood.  Bordeu  taught  that  typhoid  fever 
was  connected  with  a  general  state  of  the  system,  w^hich  he  calls  acute  scurvy? 
and  this  expression  is,  in  some  measure,  correct,  so  far  as  the  state  of  the  blood 
is  concerned.  A  diminution  in  the  quantity  of  coagulable  matter  of  the  blood! 
is  a  general  character  of  all  fevers;  in  fevers  from  miasma  we  have,  first,  ab- 
sorption of  the  poison;  and  next,  diminution  of  fibrin,  the  only  striking  change 
which  the  observant  physician  can  discover.  The  same  character  exists  in. 
typhoid  fever,  but  we  cannot  assert  that  it  is  the  cause  of  the  disease,  since  it  is 
developed  with  it,  and  becomes  more  evident  only  as  the  symptoms  increase. 

"  From  the  preceding  observations,  we  may  deduce  some  very  serious  objec- 
tions to  the  different  modes  of  treatment  of  typhoid  fever.  Were  we  to  consider 
the  state  of  the  blood  only,  we  should  reason  in  the  following  manner:  in  in- 
flammatory fever  there  is  an  augmentation  of  the  globules,  and  as  blood-letting 
is  the  best  mode  of  reducing  the  quantity  of  globules,  we  should  bleed  the  pa- 
tient. In  typhoid  fever  we  have  a  similar  increase  of  globules,  and  should 
therefore  apply  the  same  remedy;  but  we  must  never  forget  in  typhoid  fever  the 
general  derangement  of  the  economy  which  precedes  the  alteration  in  the  blood, 
and  we  cannot  say  what  effect  blood-letting  may  have  on  this  unknown  element 
of  the  disease;  hence  we  conclude,  that  the  treatment  of  typhoid  fever  can  only 
be  established  by  clinical  experience." 

The  condition  of  the  blood  in  injlammation,  M.  A.  states,  differs  according  as 
the  latter  is  acute,  subacute,  or  chronic. 

The  fibrin  is  always  increased  during  inflammation,  and  may  vary  from  4 
to  10. 

"The  globules  are  not  necessarily  augmented;  generally  speaking,  they  retain 
their  normal  standard;  in  rare  cases  are  increased;  in  others  diminished.  As 
the  inflammation  advances  the  globules  may  fall,  but  this  is  the  effect  of  blood- 
letting and  abstinence.  We  have  already  seen  that  plethoric  persons  are  not 
more  disposed  than  others  to  inflammation. 

"  Solid  contents  of  serum. — The  albumen  may  be  increased,  but  not  necessarily^ 


154  Bibliographical  Notices,  [July 

and  the  inflammation  may  attain  a  very  high  degree  of  intensity,  without  aug- 
mentation of  the  serum. 

'"''  Physical  properties. — The  clot  is  generally  very  firm  and  tenacious,  because 
the  fibrin  has  expelled  a  great  portion  of  the  serum;  in  fever,  on  the  contrary, 
the  serum  is  retained,  and  renders  the  clot  soft  and  voluminous.  In  inflamma- 
tion the  clot  is  small;  for  as  it  contains  a  large  proportion  of  fibrin,  the  globules 
are  firmly  pressed  together  by  the  contraction  of  the  coagulatiug  part  of  the 
blood." 

M.  Andral  thus  explains  the  phenomena  of  inflammation.  "  Whenever  in- 
flammation terminates  in  suppuration,  the  quantity  of  fibrin  increases;  hence, 
the  formation  of  pus  and  augmentation  of  fibrin  accompany  one  another;  we 
might,  indeed,  add  another  phenomenon,  viz.  the  formation  of  false  membranes. 
The  fibrin  is  also  augmented  in  cases  where  the  serum  is  turbid  and  mixed  with 
flocci;  on  analysing  false  membranes  they  are  found  to  be  composed  of  fibrin, 
and  this  is  confirmed  by  a  comparison  of  false  membranes  with  the  buffy  coat 
of  the  blood,  to  which  they  bear  a  perfect  resemblance. 

"  Pus  is  a  compound  fluid,  the  composition  of  which  is  not  yet  accurately 
known;  we  are  unable  to  assert  that  it  is  formed  of  fibrin,  but  in  certain  kinds  of 
pus  we  find  a  white  substance  analogous  to  fibrin.  We  may  now  ask,  how 
does  the  composition  of  the  blood  throw  any  light  on  the  formation  of  false 
membranes?  In  the  first  place,  we  are  never  able  to  detect  any  increase  in  the 
quantity  of  fibrin  until  the  symptoms  of  inflammation  are  quite  patent;  perhaps 
the  increase  is  too  small  in  the  beginning  to  be  appreciated.  In  some  cases  we 
cannot  discover  the  exciting  cause  of  inflammation,  in  others  we  can,  as  a  blister, 
for  example;  here  we  find  no  antecedent  change  of  the  blood;  hence  we  may  con- 
clude that  inflammation  arises  independently  of  any  precedent  modification  of 
the  blood;  the  same  occurs  in  cases  of  burns. 

"  Fever  exercises  no  influence  on  the  changes  which  lake  place  in  the  compo- 
sition of  the  blood.  According  to  Tomasini,  inflammation  cannot  arise  unless 
the  constitution  has  first  undergone  some  change;  every  local  disease  is  preceded 
by  some  general  condition,  which  the  Italian  physician  calls  diathesis." 

M.  A.  next  examines  how  far  the  state  of  the  blood  may  throw  light  on  the 
treatment  of  inflammation.  "  Were  we  to  depend,"  he  observes,  "  on  the  latter, 
we  should  conclude  that  blood-letting  is  less  indicated  in  inflammation  than  in 
fever,  because  its  effect  is  to  diminish  the  quantity  of  globules,  and  not  the  fibrin; 
but,  again,  we  would  observe,  the  value  of  bleeding  must  be  decided  by  expe- 
rience. Medical  opinions  are  much  divided  on  the  efficacy  of  revulsives  in  in- 
flammation; some  assert  that  it  is  increased  by  blisters;  this  idea  is  principally 
supposed  by  Tomasini;  others  think,  on  the  contrary,  that  blisters  act  bene- 
ficially, by  determining  an  irritation  of  the  skin;  others,  finally,  would  limit  the 
use  of  blisters  to  certain  periods  of  inflammation.  Experience,  in  fact,  shows 
that  blisters  aggravate  inflammation,  if  applied  at  an  early  period:  even  in  chro- 
nic inflammation  they  are  injurious  when  unseasonably  employed.  Reasoning 
on  the  facts  derived  from  humoral  pathology,  we  should  say  that  large  blisters 
must  increase  the  quantity  of  fibrin,  since  they  excite  local  inflammation,  occa- 
sionally accompanied  by  fever;  but  independent  of  this  first  effect,  we  have  ano- 
ther, consisting  in  the  abstraction  of  fibrin  from  the  circulation;  but  this  second 
effect  is  never  sufficiently  great  to  counteract  the  former  one. 

"  Boiling  water,  tartar  emetic,  &c.  act  in  the  same  way  as  blisters;  sometimes 
nothing  but  serum  is  removed  from  the  blood;  in  other  cases  serum  and  fibrin. 
The  dermis  acts  as  a  kind  of  filter,  and  prevents  the  globules  from  passing 
through.  Some  remedies  have  the  effect  of  determining  perspiration  to  the 
skin;  others  determine  to  the  intestines.  Aloes  produce  copious  liquid  stools, 
composed  chiefly  of  serum  coloured  by  the  bile:  other  purgatives  excite  the 
secretion  of  mucus,  or  merely  of  bile;  it  is  difficult  to  say  what  effects  such 
remedies  produce  on  the  blood.  Some  physicians  regard  the  preparations  of 
mercury  as  antiphlogistic.  Granting  this  to  be  the  case,  can  we  explain  their 
action?  Mercury,  it  is  said,  renders  the  blood  less  coagulable,  in  other  words, 
diminishes  the  quantity  of  fibrin;  but  this  is  mere  hypothesis." 


I 


1842.]  155 

SUMMARY 

OF  THE 

IMPROVEMENTS  AND  DISCOVERIES 

IN  THE 

MEDICAL    SCIENCES. 

ANATOMY  AND  PHYSIOLOGY. 

1 .  Abstract  of  Mr.  Goodsir^s  paper  on  the  Ultimate  Secreting  Structure,  and  on 
the  laws  of  its  Function.  (Read  at  the  Royal  Society  of  Edinburgh  on  the  30th 
March,  1842.)  After  referring-  to  the  labours  of  those  anatomists  who  had  verified 
Malpighi's  doctrine  of  the  follicular  nature  of  gland  ducts,  the  author  alluded  to 
Parkinje's  hypothesis  of  the  secreting  function  of  the  nucleated  corpuscles 
which  line  these  ducts.  In  a  rapid  sketch  of  the  results  of  inquiries  since  the 
appearance  of  Miiller's  work  "  De  Penitiore  Structura  Glandularum,"  and  more 
particularly  of  the  observations  of  Henle  and  others  on  the  closed  vesicles  which 
are  situated  at  the  extremities  of  certain  ducts,  Mr.  Goodsir  stated,  that  no  anat- 
omist had  hitherto  "proved  that  secretion  takes  place  within  the  primitive  nu- 
cleated cell  itself,  or  had  pointed  out  the  intimate  nature  of  the  changes  which 
go  on  in  a  secreting  organ  during  the  performance  of  its  function." 

Numerous  examples  were  now  given  of  secretions  detected  in  the  cavities  of 
nucleated  cells  of  various  glands  and  secreting  surface.  Among  these  secretions 
were  the  ink  of  the  cephalopoda  and  the  purple  of  janthina  and  aplysia,-  bile  in 
an  extensive  series  selected  from  the  principal  divisions  of  the  animal  kingdom; 
urine  in  the  mollusk;  milk,  &c. 

The  wall  is  believed  by  the  author  to  be  the  part  of  the  cell  engaged  in  the 
process  of  secretion.  The  cavity  contains  the  secreted  substance,  and  the  nu- 
cleus is  the  reproductive  organ  of  the  cell.  A  primitive  cell  engaged  in  secre- 
tion is  denominated,  by  the  author,  a  primary  secreting  cell;  and  each  cell  of 
this  kind  is  endowed  with  its  own  peculiar  property,  according  to  the  organ  in 
which  it  is  situated.  The  discovery  of  the  secreting  agency  of  the  primitive 
cell  does  not  remove  the  principal  mystery  in  which  the  function  has  always 
been  involved;  but  the  general  fact  that  the  primitive  cell  is  the  ultimate  secret- 
ing structure,  is  of  great  value  in  physiological  science,  inasmuch  as  it  connects 
secretion  with  growth  as  functions  regulated  by  the  same  laws,  and  explains  one 
of  the  greatest  difficulties  in  physiology,  viz.  why  a  secretion  flows  from  the 
free  surface  only  of  a  secreting  membrane — the  secretion  exists  only  on  the  free 
surface  inclosed  in  the  ripe  cells  which  constitute  that  surface. 

The  author  then  proceeded  to  the  consideration  of  the  origin,  the  develop- 
ment, and  the  disappearance  of  the  primary  secreting  cell,  a  subject  which 
necessarily  involved  the  description  of  the  various  minute  arrangements  of 
glands,  and  other  secreting  organs.  After  describing  the  changes  which  occur 
in  the  testicle  of  the  squalus  cornubicus,  when  the  organ  is  in  a  state  of  functional 
activity,  and  in  the  Viver  of  car cinusmoenas,  it  was  stated  that  these  were  selected 
as  examples  of  two  orders  of  glands,  denominated  by  the  author  vesicular  and 
follicular.  The  changes  which  occur  in  the  first  order  of  glands  consist  in  the 
formation  and  disappearance  of  closed  vesicles  or  acini.  Each  acinus  might  be 
first  a  single  cell,  denominated  by  the  author  the  primary  or  germinal  cell;  or, 


156  Progress  of  the  Medical  Sciences,  [July 

secondly,  of  two  or  more  cells  enclosed  in  the  primary  cell,  and  produced  from 
its  nucleus.  The  enclosed  cells  he  denominates  the  secondary  cells  of  the  aci- 
nus, and  in  the  cavities  of  these,  between  their  nuclei  and  cell  walls,  the  pecu- 
liar secretion  of  the  gland  is  contained.  The  primary  cell,  with  its  included 
group  of  cells,  each  full  of  secretion,  is  appended  to  the  extremity  of  one  of  the 
terminal  ducts,  and  consequently  does  not  communicate  with  that  duct,  a  dia- 
phragm formed  by  a  portion  of  the  primary  cell  wall  stretching  across  the  pedi- 
cle. When  the  secretion  in  the  group  of  included  cells  is  fully  elaborated,  the 
diaphragm  dissolves  or  gives  way,  the  cells  burst,  and  the  secretion  flows  along 
the  ducts,  the  acinus  disappearing,  and  making  room  for  a  neighbouring  acinus, 
w^hich  has  in  the  mean  time  been  advancing  in  a  similar  manner.  The  whole 
parenchyma  of  glands  of  this  order  is  thus,  according  to  Mr.  Goodsir,  in  a  con- 
stant state  of  change — of  development,  maturity,  and  atrophy, — this  series  of 
changes  being  directly  proportional  to  the  profuseness  of  the  secretion. 

In  the  second  order  of  glands,  the  follicular,  as  exemplified  in  the  liver  of  car- 
cinus^  the  germinal  cell  or  spot  is  situated  at  the  blind  extremity  of  the  follicle, 
and  the  secreting  cells,  as  they  advance  along  the  follicle,  become  distended 
with  their  peculiar  secretion. 

Among  other  general  conclusions  deducible  from  these  observations,  it  ap- 
peared that  ducts  are  to  be  considered  as  inter-cellular  passages  into  which  the 
secretions  formed  by  cells  are  cast. 

Finally,  the  author  inferred  from  the  whole  inquiry,  1st,  That  secretion  is  a 
function  of,  and  takes  place  within  the  nucleated  cell;  and,  2d,  Growth  and 
secretion  are  identical, — the  same  process  under  different  circumstances. — Lon, 
and  Edin.  Montfily  Journ.  Med.  Sci.,  May,  1842. 

2.  Structure  of  the  human  hidney  and  the  changes  it  undergoes  in  the  granular 
degeneration. — Mr.  Goodsir  submitted  to  the  Medico-Chirurgical  Society  of 
Edinburgh  April  6th,  1842,  the  result  of  his  researches  into  the  structure  of  the 
healthy  human  kidney,  and  into  the  changes  which  it  undergoes  in  the  granular 
degeneration  described  by  Dr.  Bright.  Without  denying  the  existence  of  occa- 
sional blind  extremities  of  the  tubuli  uriniferi,  the  result  probably,  of  arrested 
development,  the  author  stated  that  he  had  never  seen  the  ducts  terminating  in 
this  way.  He  then  described  a  structure,  which  appears  hitherto  to  have  been 
overlooked  by  anatomists,  namely,  a  fibro-cellular  framework,  which  pervading 
every  part  of  the  gland,  and  particularly  its  cortical  portion,  performs  the  same 
important  part  in  the  kidney,  which  the  capsule  of  Glisson  does  in  the  liver, 
forming  a  basis  of  support  to  the  delicate  structure  of  the  gland,  conducting  the 
blood-vessels  through  the  organ,  and  forming  small  chambers  in  the  cortical 
portion,  in  each  of  which  a  single  ultimate  coil  or  loop  of  the  uriniferous  ducts 
is  lodged.  Mr.  Goodsir  believes,  that  the  urine  is  formed  at  first  within  the 
so-called  epithelium  cells  of  the  ducts,  and  that  these  burst,  dissolve,  and  throw 
out  their  contents,  and  are  succeeded  by  others  which  perform  the  same  func- 
tions. The  urine  of  man  has  not  been  detected  by  the  author  within  the  cells 
which  line  the  ducts,  but  he  has  submitted  to  the  Royal  Society  of  Edinburgh, 
within  the  last  few  weeks,  a  memoir,  in  which  he  has  proved  that  the  urine,  bile, 
milk,  as  well  as  the  other  more  important  secretions  in  the  lower  animals,  are 
formed  within  the  nucleated  cells  of  the  gland  ducts.  He  believes,  therefore, 
that  the  urine  of  man  is  poured  at  first  into  the  cavities  of  the  nucleated  cells  of 
the  human  kidney. 

In  proceeding  to  describe  the  morbid  changes  which  he  had  detected  in  kid- 
neys, in  the  various  stages  of  the  granular  disease  of  Bright,  the  author  of  the 
paper  did  not  pretend  to  decide,  whether  these  changes  originated  in  inflamma- 
tion, or  simply  in  congestion  of  the  gland.  He  reminded  the  society  of  those 
changes,  which  at  a  former  meeting  he  had  announced  as  occurring  in  the  vesi- 
cular glands  of  the  intestine  during  fever,  namely,  the  formation  and  progressive 
increase  of  nucleated  cells,  (probably  aberrant  forms  of  the  epithelium  which 
line  the  vesicles,)  within  the  vesicles  of  the  patches.  He  now  stated,  that 
granular  degeneration  of  the  kidney  was  a  similar  decrease;  that  it  consisted 


1842.]  Anatomy  and  Physiology.  157 

essentially  of  the  formation  of  nucleated  cells  within  the  uriniferous  ducts;  that 
these  new  cells  were  principally  confined  to  the  ultimate  loops  of  the  duct; 
but  that  in  advanced  stag-es  of  the  disease,  they  might  be  formed  even  in  the 
tubes  of  the  pyramids  of  Ferrien, — that  when  a  sing-le  ultimate  loop  of  the  uri- 
niferous ducts  was  gorged  or  distended  with  the  increasing  mass  of  germinating 
cells,  or  when  two  or  more  neighbouring  loops  were  in  this  condition,  the  little 
mass  constituted  one  of  the  granulations  characteristic  of  the  milder  forms  of  the 
disease, — that  when  throughout  the  gland,  or  in  certain  portions  of  it,  the  ger- 
minating masses  had  so  far  distended  the  ducts  and  loops,  as  to  cause  their  dis- 
appearance, and  to  induce  absorption  of  the  walls  of  the  little  chambers  of  the 
fibro-cellular  capsule,  and  consequently  of  the  uriniferous  ducts,  the  whole  of  the 
cortical  portion  of  the  gland,  or  that  part  of  it  more  particularly  affected,  as- 
sumed the  appearance  presented  in  the  more  advanced  stages  of  the  disease.  If 
the  patient  survives  the  stage  last  described,  the  kidney  becomes  partially  or 
wholly  atrophied, — a  change  due  to  the  contraction  of  fibrous  tissue,  produced 
either  from  the  cells  which  constitute  the  disease,  or  from  cells  resulting  from 
effused  fibrin.  With  the  exception  of  the  primary  engorgement  of  the  capillary 
system,  and  of  the  Malpighian  corpuscles,  and  their  subsequent  diminution, 
Mr.  Goodsir  had  not  observed  any  very  marked  change  in  the  vascular  system 
of  the  kidney  during  granular  degeneration  of  the  organ. 

In  proceeding  to  describe  certain  parts  of  the  healthy  and  morbid  structure  of 
the  human  liver,  the  author  observed,  that  very  little  remained  to  be  done  in 
reference  to  this  gland,  since  the  very  admirable  researches  of  Mr.  Kiernan.  In 
regard  to  two  parts  of  the  structure,  however,  we  were  yet  quite  in  the  dark, 
namely,  the  mode  of  termination  of  the  hepatic  ducts,  and  the  connection  be- 
tween them  and  the  nucleated  cells  of  this  organ.  He  had  been  able,  after  con- 
siderable difficulty,  to  verify  Mr.  Kiernan's  supposition,  that  the  hepatic  ducts 
terminate  by  a  network  within  the  lobules  of  the  liver,  around  the  intra-lobular 
"veins.  But  the  most  important  feature  in  the  observations  of  the  author,  was 
the  detection  of  the  real  connection  between  these  ultimate  ducts  and  the  nu- 
cleated cells.  These  he  found  to  be  grouped  in  the  form  of  acini  on  the  sides 
of  the  duct.  Each  acinus  might  consist,  first,  of  a  single  cell,  denominated  by 
the  author  the  primary  or  germinal  cell  of  the  future  acinus;  or,  secondly,  of  two 
or  more  cells  enclosed  in  the  primary  cell,  and  produced  from  its  nucleus.  The 
enclosed  cells  he  denominates  the  secondary  cells  of  the  acinus;  and  in  the  cavi- 
ties of  these,  between  their  nuclei  and  cell  walls,  the  bile  and  a  few  oil-like 
globules  are  contained,  as  he  had  already  stated  in  the  memoir  above  alluded  to. 
The  primary  cell,  with  its  included  group  of  cells,  each  full  of  bile,  is  appended 
to  the  side  of  the  remote  ducts,  and,  consequently,  does  not  communicate  with 
that  duct,  a  diaphragm  formed  by  a  portion  of  the  primary  cell  wall  stretching 
across  the  pedicle.  When  the  bile  in  the  group  of  included  cells  is  fully  elabo- 
rated, the  diaphragm  dissolves  or  gives  way,  the  cells  burst,  and  the  bile  flows 
along  the  ducts;  the  acinus  disappearing,  and  making  room  for  a  neighbouring 
acinus,  which  has  in  the  mean  time  been  advancing  in  a  similar  manner.  The 
whole  parenchyma  of  the  liver,  then,  is,  according  to  Mr.  Goodsir,  "  in  a  con- 
stant state  of  change, — of  development,  maturity,  and  atrophy;  this  series  of 
changes  being  directly  proportioned  to  the  profuseness  of  the  secretion  of  bile." 
The  author  now  stated,  that  he  found  himself  anticipated  by  Mr.  Bowman,  in 
regard  to  one  of  the  morbid  conditions  of  the  human  liver,  namely,  the  fatty 
liver.  He  had,  however,  much  pleasure  in  confirming  that  gentleman's  obser- 
vation {Lancet^  Jan.  1842)  as  to  the  fat  being  deposited  within  the  nucleated 
cells  of  the  organ,  and  to  be  considered,  in  fact,  as  a  redundancy  of  the  oil 

f  lobules  naturally  existing  in  these  cells.  It  was  then  stated,  that  as  in  the 
idney,  so  in  the  liver,  contractile  fibrous  tissue  might  be  developed,  and  pro- 
duce partial  or  complete  atrophy.  Dr.  Carswell  had  already  indicated  this  as 
existing  in  cirrhosis.  The  matter  of  which  the  rounded  masses  in  cirrhosis  con- 
sist, was  not  considered  by  Mr.  Goodsir  as  a  new  deposit,  but  merely  as  the 
natural  tissue  of  the  liver,  altered  by  the  pressure  exerted  by  their  fibrous  enve- 
lopes. These  alterations  consist  in  constriction,  more  or  less  powerful,  of  the 
No.  Vn.— July,  1842.  14 


158  Progress  of  the  Medical  Sciences,  [J»ly 

vessels  and  ducts  which  pass  out  and  in  to  the  rounded  mass;  the  necessary 
difficulty  with  which  the  circulation  is  carried  on,  and  the  bile  advanced  along 
the  ducts;  and,  latterly,  in  a  change  in  the  constitution  of  the  nucleated  cells 
themselves,  which,  instead  of  being-  distended  with  bile  containing  oil-like 
globules,  contains  matter  of  a  darker  colour  and  less  oil.  The  cells  may  at  last 
contain  matter  perfectly  black,  and  then  the  rounded  mass  assumes  the  appear- 
ance of  a  melanotic  tubercle,  the  black  cells  in  some  instances  becoming  pyri- 
form  and  caudate.  The  author  did  not  state  the  exact  nature  of  the  proximate 
cause  of  these  various  changes  in  the  liver,  although  he  is  inclined  to  believe 
that  the  forms  of  cirrhosis  and  melanosis  are  due  to  the  contractile  tissue,  as  a 
product  of  inflammatory  action  more  or  less  acute.  The  action  of  remedies,  par- 
ticularly of  mercury,  would  appear  to  corroborate  this  opinion.  Finally,  he  con- 
cluded, from  the  observations  which  he  had  made  on  the  morbid  anatomy  of  the 
human  liver  and  kidney,  that  certain  of  the  diseases  of  these  organs  are  due  to 
the  development  of  new  cells  and  new  matter,  within  the  ducts  and  nucleated 
cells  of  the  organs,  in  accordance  with  the  normal  laws  of  cellular  development, 
this  cellular  vegetation  at  last  destroying,  more  or  less  completely,  the  natural 
tissue  of  the  organ. — Ibid, 

3.  Arrangement  of  the  eighth  pair  of  nerves. — Mr.  Spence  exhibited  to  the 
Med.  Chir.  Soc.  of  Edinburgh  (April  6,  1842),  the  preparation  and  drawings  of 
a  dissection  of  the  eighth  pair  of  nerves,  showing  that  all  the  filaments  of  the 
par  vagum  did  not  pass  the  ganglia  on  that  nerve;  but  that  a  portion  of  the 
vagus  could  be  traced  passing  over  its  superior  ganglion,  and  that  this  portion, 
after  having  been  joined  by  the  internal  root  of  the  spinal  accessory,  and  giving 
oflf  the  pharyngeal  branches  of  the  vagus,  likewise  passed  over  its  second  gan- 
glion, and  could  be  traced  into  the  recurrent  laryngeal  nerve.  Mr.  S.  remarked, 
that  this  anatomical  arrangement  of  the  nerve  satisfactorily  accounted  for  the 
seemingly  anomalous  fact,  that  the  vagus,  an  apparently  ganglionic  nerve, 
should  send  off  motor  branches,  as  these  dissections  showed  that  it  contained 
motor  filaments  distinct  from  the  ganglionic  portion,  and  also  distinct,  for  some 
distance,  from  the  superior  filaments  of  the  accessory  described  by  Bendz.  He 
then  made  some  remarks  on  the  experiments  of  M.  BischoflT,  Dr.  J,  Reid,  and 
M.  Longet  of  Paris,  to  show  that  these  experiments  and  the  anatomy  mutually 
illustrated  each  other. — Ibid, 

4.  Singular  case  of  Monstrosity. — Dr.  Rodenstab,  in  a  communication,  enti- 
tled Practical  Remarks  on  Labour,  published  in  the  "  Neue  Zeitschrift,  fur  die 
Geburtskunde,"  has  given  the'  particulars  of  the  birth  of  a  living  monstrosity, 
without  any  cranium.  The  mother  was  delivered  by  the  forceps.  A  fortnight 
after  birth,  points  of  ossification  were  developed  in  different  parts  of  the  head, 
and  at  the  end  of  two  months,  the  cranium  resembled  that  of  an  ordinary  newly- 
born  infant.  The  child,  a  male,  three  years  old  at  the  date  of  the  report,  difiers 
only  from  other  children  by  the  great  size  of  the  fontanelle. — Prov.  Med,  and 
Surg.  Journ.  May  14,  1842. 

5.  Experiments  on  the  Saliva  obtained  from  a  man  labouring  under  fistula  of  the 
right  parotid  duct  near  its  extremity.  By  Messrs.  Garrod  and  Marshall. — 
Reactions. — Tiedemann  and  Gmelin  found  it  generally  slightly  alkaline,  some- 
times neutral,  but  never  acid.  Schultz  found  it  acid  in  the  adult  when  retained 
in  the  mouth — alkaline  in  children.  Mitscherlich,  who  observed  it  in  a  case  of 
parotid  fistula,  found  it  acid  when  not  eating,  alkaline  during  a  meal.  Other 
observers  have  come  to  similar  conclusions;  but  most  consider  that  it  is  capa- 
ble of  varying  under  very  slight  circumstances.  Messrs.  Marshall  and  Gar- 
rod  found  that  between  meals  the  fluid  issuing  from  the  fistulous  opening, 
amounting  to  two  or  three  drops  in  the  quarter  of  an  hour,  was  always  acid,  but 
within  half  a  minute  after  a  morsel  had  been  taken  it  became  neutral,  and  within 
the  minute  alkaline:  it  soon  became  strongly  alkaline,  and  remained  so  till  the 
completion  of  the  meal.     About  ten  minutes  after  the  meal  it  again  became  neu- 


:v:^ 


1842.]  Anatomy  and  Physiology.  159 

tral,  and  acid  in  about  twenty  minutes,  and  remained  so  till  the  next  meal.  The 
only  exceptions  were  during  cough,  which,  when  slight,  produced  an  increased 
flow  of  saliva;  and  it  often  became  neutral  for  a  minute,  but  soon  returned  to 
its  acid  state.  When,  however,  the  cough  was  long  continued,  the  fluid  not 
only  became  neutral  but  even  alkaline;  but  it  soon  returned  to  its  acid  state 
when  the  fit  of  coughing  was  over. 

When  the  fluid  issuing  from  the  fistula  was  acid,  then  also  blue  test-paper  be- 
came reddened  when  applied  above  and  below  the  tongue,  and  also  to  the  open- 
ing of  the  other  parotid  duct;  and  when  the  fluid  was  alkaline  at  the  fistula,  so 
were  the  surfaces  above  mentioned. 

These  experiments  were  repeated  many  times  in  the  presence  of  Dr.  Sharpey, 
Mr.  Listen,  and  many  other  gentlemen,  and  always  with  the  same  results. 
Once  only  was  the  fluid  from  fistula  (during  rest)  found  to  be  alkaline,  and  then 
it  was  found  to  be  owing  to  a  drop  of  pus,  which,  being  removed,  the  acid  indica- 
tion was  given. 

Reasoning  on  these  facts,  and  not  thinking  it  probable  that  a  secretion  could 
change  from  acid  to  alkaline  in  so  short  a  time,  the  more  from  its  not  being 
excited  by  mental  emotions  only  (as  the  sight  of  food,  &c.)  but  also  by  cough- 
ing, or  motion  of  the  masticating  organs,  Mr.  Garrod  endeavoured  to  explain  it 
otherwise;  viz.,  by  supposing  that  the  acidity  was  owing  to  the  mucous  secre- 
tion of  the  duct,  &c.,  and  that  the  true  saliva  was  always  alkaline.  Then, 
when  the  saliva  is  flowing  but  very  slowly,  as  between  meals,  &c.,  the  alka- 
linity of  the  saliva  would  not  be  able  to  neutralise  the  acid  mucus  constantly 
secreted,  and  the  indication,  therefore,  would  be  acid;  but  when  the  saliva  was 
excited  to  an  increased  flow,  this  first  neutralised,  then  more  than  neutralised, 
the  acidity  of  the  mucus,  and  the  indications  would  be  first  neutral,  then  alka- 
line; and,  of  course,  when  the  flow  of  saliva  was  diminished  again,  it  would 
pass  through  the  same  changes.  But  it  was  found  that  the  fluid  became  alka- 
line in  about  a  minute,  but  did  not  recover  its  acid  state  for  twenty  minutes 
after  the  meals.  This  is  also  explained  by  the  above  theory;  for  when  the 
saliva  is  excited,  the  quantity  is  so  great  compared  with  the  mucus,  that  it  soon 
overpowers  it,  and  for  the  same  reason  it  would  be  long  in  recovering  its  acidity 
after  the  meal  was  completed. 

But  is  mucus  or  are  all  mucous  surfaces  acid?  for  to  establish  this  theory  it 
was  required  to  prove  this.  A  four-month  foetus  was  examined  by  Mr.  Mar- 
shall, and  it  was  found  that  a  strong  acid  indication  was  given  by  the  mucous 
membranes  of  the  mouth,  nose,  anus,  and  vagina:  these,  of  course,  were  unin- 
fluenced by  the  special  secretions  which  vitiate  the  experiments  in  the  living 
subject,  and  which  frequently  are  alkaline,  as  the  tears,  &c.  The  lining  mem- 
brane of  the  parotid  duct  in  the  sheep  was  examined,  and  was  found  likewise  to 
be  acid. 

Smoking  a  pipe  in  this  case  did  not  increase  the  flow  of  saliva — only  three  or 
four  drops  of  fluid  issued  from  the  ducts  during  the  experiment,  which  was 
strongly  acid.  The  state  of  the  mouth  was  examined,  yet  notwithstanding  the 
alkaline  state  of  the  smoke,  was  found  to  be  intensely  acid,  and  the  quantity  of 
the  mucus  was  increased.  These  experiments  seem  clearly  to  prove  the  acidity 
of  mucus. 

Chemical  composition. — The  alkaline  state  was  not  owing  to  free  ammonia,  as 
Schultz  asserted;  for  the  fluid,  when  kept  at  a  high  temperature,  did  not  lose  its 
alkaline  state:  the  distilled  fluid  was  not  alkaline,  and  the  papers  made  blue  did 
not  recover  their  redness  when  exposed  to  heat.  Potassa  was  not  found  in  the 
fluid,  so  it  depended  probably  on  free  soda. 

Sulphocyanogen. — This  has  been  asserted  to  exist  in  the  saliva  by  some,  but 
denied  by  others. 

The  tests  used  in  the  experiments  of  Messrs.  Garrod  and  Marshall  were  the 
action  of  the  per-salts  of  iron,  or  the  production  of  sulphuretted  hydrogen  from 
the  fluid.  A  sulphocyanide  colours  the  per-salts  of  iron  blood-red;  but  the  ace- 
tates, formiates,  and  meconic  acid  do  the  s^ame.  But  it  is  found,  that  when  a 
crystal  of  corrosive  sublimate  is  added  to  the  fluid,  coloured  by  the  sulphocya- 


160  Progress  of  the  Medical  Sciences.  U^^Y 

nide,  that  the  colour  vanishes.  This  does  not  happen  with  the  fluid  reddened 
by  the  other  substances.  Heat  also  destroys  the  colour  of  the  sulphocyanide 
for  the  time;  not  so  with  the  others. 

A  piece  of  pure  zinc  and  sulphuric  acid  were  put  into  a  test-tube;  the  hydro- 
gen evolved  gave  no  trace  of  sulphur  to  lead-paper  for  half  an  hour,  but  when  a 
few  drops  of  healthy  saliva  were  added,  the  lead-paper  became  blackened  im- 
mediately, and  the  sulphuretted  hydrogen  was  also  sensible  to  the  nose. 

Great  care  is  required  in  this  experiment  to  procure  the  zinc  very  pure,  as 
sulphur  is  generally  contained  in  it,  and  will  vitiate  the  experiment.  But  this 
might  be  owing  to  the  albumen,  which  contains  sulphur  as  an  essential  ingre- 
dient, or  to  a  soluble  sulphuret.  To  obviate  this  an  alcoholic  solution  of  saliva 
was  made,  which  could  not  contain  albumen,  which  also  gave  the  indications  of 
sulphur.  It  was  not  owing  to  a  soluble  sulphuret,  for  the  alcoholic  solution 
did  not  blacken  lead-paper.  Now  the  sulphuret  of  lead  is  black,  but  the  sul- 
phocyanide is  of  a  light  yellow  colour. 

If  further  proof  were  wanting  of  the  presence  of  sulphocyanogen  in  the  saliva, 
it  was  found  that  when  the  solution  ceased  to  evolve  sulphuretted  hydrogen, 
then  also  it  ceased  to  give  the  red  colour  with  the  per-salts  of  iron.  As  no 
potassa  or  ammonia  was  found  in  the  saliva,  the  sulphocyanogen  probably  exists 
in  it,  as  a  sulphocyanide  of  soda.  Mr.  Garrod  then  alluded  to  the  experiments 
of  Dr.  Davidson,  on  the  absence  of  sulphocyanogen  from  the  saliva  in  certain 
diseases,  as  pytalism,  fevers,  &c.,  and  remarked,  that  during  the  time  the  man 
was  under  the  influence  of  mercury  the  sulphocyanogen  was  almost  entirely 
absent,  becoming  apparent  only  by  concentration  (but  the  pytalism  in  this  case 
was  slight),  and  it  seemed  to  return  as  the  pytalism  abated;  but  the  operation 
for  the  fistula  prevented  their  continuing  the  experiments.  The  man  was 
labouring  under  phthisis  also,  and  perhaps  this  might  reduce  the  quantity  of 
sulphocyanogen  in  the  saliva. 

The  quantity  of  solid  matter  found  in  the  saliva  was  1.7  in  100,  it  is  usually 
stated  to  be  about  1.  in  100;  but  this  increase  might  be  owing  to  albumen, 
which  was  distinctly  indicated  by  means  of  heat  and  nitric  acid.  Albumen  is 
not  usually  considered  one  of  the  constituents  of  healthy  saliva.  The  quantity 
of  saliva  from  the  fistula  was  found  to  be  from  two  to  four  drachms  during  a 
meal,  but  the  man's  appetite  was  not  very  good.  The  saliva  was  found  to 
change  a  solution  of  starch,  so  that  it  no  longer  gave  the  blue  colour  with 
iodine.  The  alcoholic  extract  of  the  changed  starch  was  found  to  have  a 
slightly  saccharine  taste;  so  probably  a  part  of  the  starch  was  converted  into 
sugar,  the  rest  being  only  converted  into  dextrine. 

Microscopic  characters. — Under  the  microscope  the  saliva  was  found  to  con- 
sist of  a  clear  fluid,  containing  epithelium  scales,  small  granules,  and  also  true 
salivary  globules,  about  -^-^-^^  inch  in  diameter.  A  nucleus  was  distinctly  visi- 
ble in  each  when  a  drop  of  sulphurous  acid  was  added.  This  nucleus  seems  to 
be  situated  rather  to  one  side  of  the  globule. — Lancet,  March  12,  1842. 

6.  Observations  on  Parasitical  growths  on  Jiving  animals.  By  Dr.  Busk, 
Esq.,  Surgeon  to  the  Hospital  Ship,  Dreadnaught,  &c. — The  occurrence  of  para- 
sitical growths,  or  of  organized  productions,  having  a  close  analogy  with  some 
forms  of  cryptogamic  vegetation,  upon  the  surfaces  or  within  the  substance  of 
living  animals,  and  in  many  instances  constituting  the  cause  of  disease,  is  a 
subject  of  considerable  importance  in  pathology;  and  although  it  would  be  out 
of  place  in  these  pages  to  enter  into  the  pathological  relations  of  these  affections, 
yet  as  the  microscope  has  been  the  means  by  which  the  few  facts  as  yet  ascer- 
tained in  this  matter  have  been  brought  to  light,  it  may  not,  perhaps,  be  deemed 
irrelevant  to  the  object  of  the  Microscopic  Journal,  to  admit  a  short  statement 
of  what  has  been  observed,  and  thus  to  bring  into  one  point  of  view,  and  attract 
the  attention  of  microscopists,  to  a  probably  not  unfertile  field  of  investigation. 

1.  On  the  28th  of  August,  1832,  Mr.  Owen  read  some  notes  before  the  Zoo- 
logical Society  on  the  anatomy  of  the  Flamingo,  {Phcenicopterus  ruber,)  in  the 


1842.]  Anatomy  and  Physiology.  161 

lungs  of  which  bird  he  found  numerous  tubercles  and  vomicae,  the  inner  surface 
of  which  latter  was  covered  with  a  greenish  vegetable  mould  or  macor.  Mr. 
Owen  presumed  that  the  growths  had  taken  place  during  the  life  of  the  animal, 
and  thence  concluded  that  internal  parasites  are  not  derived  exclusively  from  the 
animal  kingdom,  but  that  there  are  Entophyta  as  well  Entozoa.* 

2.  In  the  year  1835  a  disease  to  which  silkworms  are  subject,  known  under 
the  name  of  Muscardine,  was  first  described  by  M.  Bassi  of  Lodi,  and  M.  Bal- 
samo,  a  botanist  of  Milan.  They  ascertained  that  this  disease  was  owing  to  the 
growth,  on  or  within  the  body  of  the  caterpillar,  of  a  cryptogamic  vegetation.  M. 
Audouin,  in  1836  and  1837,  in  a  paper  entitled  "  Anatomical  and  Physiological 
Researches  on  the  contagious  disease  which  attacks  silkworms,  and  which  is 
designated  under  the  name  of  Muscardine,^^-f  described  a  series  of  experiments 
on  the  chrysalis  of  Bomyx  Mori  thus  affected,  and  which  he  had  received  from 
M.  Bassi.  He  was  able  to  follow  in  detail  the  transformation  of  the  fatty  tissue 
of  the  insect  into  radicles  (thallus  of  the  cryptogamic  vegetation,  to  which  he 
gave  the  name  of  Botrytis  Bassiana.X 

3.  The  next  observation  is  that  of  M.  Des  Longchamps,§  in  a  paper"  On  the 
habits  of  the  Eider  Duck  {Anas  mollissima),^''  in  which  he  describes  the  occur- 
rence of  layers  oi  mouldiness  developed  during  life,  on  the  internal  surface  of  the 
aerial  cavities  of  one  of  these  birds,  which  he  examined  on  the  2d  July, 
1840,  while  yet  warm.  This  vegetation  occurred  in  the  form  of  flakes  or  layers, 
deposited  in  great  numbers  on  the  walls  of  these  cavities.  Most  of  these  plates, 
or  layers,  were  circular,  and  they  varied  in  size  from  two  or  three  millimetres  to 
several  centimetres.  The  small  bronchial  tubes  were  covered  with  them  in  great 
abundance.  Two  kinds  of  these  plates  or  flakes  were  observed.  Beneath  the 
larger  ones  the  membrane  upon  which  they  were  situated  was  uniformly  redden- 
ed and  thickened;  beneath  the  smaller  ones,  towards  the  centre,  a  vascular  net- 
work was  seen,  surrounded  by  a  zone,  in  which  the  vascularity  was  less  dis- 
tinct, and  beyond  this  zone  the  vascularity  was  again  increased,  but  in  less 
degree  than  in  the  centre.  The  colour  of  the  smaller  flakes  was  a  dirty  white; 
the  larger  ones  were  also  white,  but  greenish  in  the  centre.  The  border  of  the 
larger  flakes  was  irregular,  which  irregularity  evidently  resulted  from  their  being 
formed  hy  the  confluence  of  several  adjoining  smaller  flakes.  Examined  under 
the  microscope,  this  mouldiness  appeared  to  be  composed  of  transparent  non- 
articulated  filaments,  slightly,  if  at  all  branched,  and  intermixed  like  the  fibres 
of  felt.  These  filaments,  imbedded  in  a  layer  of  albumen,  were  in  parts  scarcely 
the  -gJ^y  of  a  millimetre  in  diameter.  M.  D.  further  observed  numerous  ovoid 
or  globular  vesicles  in  the  felt-like  mass,  of  the  same  diameter  as  the  filaments, 
which  vesicles  he  looked  upon  as  sporules.  These  growths  appeared  to  have 
no  immediate  connection  with  the  living  tissue. 

4.  A  mouldiness  of  a  diflferent  kind  was  also  observed  by  MM.  Rousseau  and 
Serrurier,||  which  they  describe  as  being  found  not  unfrequently  in  pigeons  and 
fowls,  particularly  in  cold  and  humid  situations,  or  in  rainy  seasons.  These 
observers  found  it  in  the  body  of  a  male  parroquet,  which  died  of  a  tubercular 
disease,  in  a  sort  of  false  membrane  between  the  intestines  and  vertebral  column, 
which  membrane  was  covered  with  a  greenish  pulverulent  mouldiness,  so  light, 
and  so  little  adherent,  that  it  could  be  blown  off  as  a  fine  powder.  They  further 
state,  that  a  similar  aflfection  has  been  noticed  by  them  in  animals  of  other 
classes,  as  in  Cervus  Axis,  and  Testudo  Indica, 

*  Philosophical  Magazine,  1833.     New  Series,  vol.  ii.  p.  71. 

t  Annalcs  des  Sciences  Naturelles,  vol.  viii.,  new  series,  p.  229,  pi.  10,  11. 

X  For  farther  observations  on  this  disease,  vide  a  paper  by  M.  Johanny,  Annales  des 
Sciences  Naturelles,  vol.  ix.  p.  65,  80;  and  one  by  M.  Crivelli,  in  Schleclendahl's  Lin- 
naea,  118,  123;  and  by  M.  Bonafous,  L'Institut,  clxxix.  p.  154;  and  Henle's  Patholo- 
gisch.  Untersuchung. 

k  Annales  des  Sciences  Naturelles,  June  1841,  p.  371. 

II  Comptes  Rendus,  1841. 

14* 


162  Progress  of  the  Medical  Sciences.  [J"ly 

5.  In  1839,  M.  Schcenlein*  announced  the  fact  of  the  existence  of  My  coder' 
mata  in  the  crusts  of  Tinea  Favosa.  Priority,  however,  in  this  observation,  is 
claimed  by  M.  Remak,f  who  says  that  he  made  it  as  far  back  as  1836,  when  he 
stated  that  Tinea  Favosa  consisted  of  fungoid  filaments.:}: 

On  the  announcement  of  Schoenlein's  experiments  in  1839,  they  were  repeated 
by  MM.  Fuchs  and  Langenbeck  at  Gottingen,  who  supposed  that  they  proved 
the  existence  of  mucores,  not  only  in  the  crusts  of  true  Tinea,  {Porrigo  favosa 
and  F.  lupinosa,)  but  also  in  the  majority  of  eruptions  belonging  to  what  they 
term  cutaneous  scrofula,  for  instance,  in  the  crusts  of  Impetigo  scrofulosa,  and 
in  those  of  serpiginous  ulcers.  These  researches  are  published  by  M.  Fuchs, 
in  his  Compte  Rendu  of  the  Polyclinique  of  Gottingen,  in  the  Ann.  Hanov.  de  M. 
Holscher,  Cahier  de  1840,  and  still  later  in  the  first  volume  of  his  Traite  des 
maladies  de  la  peau^  Gottingen,  1840. 

Latterly,  however,  a  much  fuller  and  more  correct  description  of  this  disease 
has  been  given  by  M.  Gruby,  of  Vienna,§  who  states  that  the  crusts  of  Tinea 
favosa  contain,  or  in  fact  are  made  up  of  aggregated  My  coder  mata.  This  growth 
consists  of  numerous  corpuscles,  rounded  or  oblong,  the  longitudinal  diameter  of 
which  is  from  about  the  jToV^h,  to  the  i^o^^  of  a  millim,  and  the  transverse  from 
the  ^|o"th  to  the  ilo^^.  They  are  transparent,  with  a  defined  border,  and  smooth 
surface;  colourless,  or  slightly  yellow,  and  homogeneous.  The  corpuscles  are 
either  separate,  or,  by  their  apposition  end  to  end,  constitute  beaded  or  articula- 
ted filaments,  which  are  simply  cylindrical  or  branched,  according  to  the  part  of 
the  crust  in  which  they  are  found.  Besides  these  beaded  filaments,  other  much 
smaller  branched  filaments  are  to  be  observed,  which  are  furnished  at  certain 
distances  with  partitions,  (cloisons  vegetales,)  and  thus  represent  oblong  cells, 
in  which  are  found  very  minute  round,  transparent  molecules.  Occasionally, 
some  granules  were  found  adherent  to  these  filaments,  similar  to  the  spores  of 
Torula  olivacea,  and  T.  sacchari.\\  The  form  of  these  filaments  is  considered  by 
M.  Gruby  a  sufficient  proof  of  their  vegetable  character,  and  according  to  M. 
Brongniart,  they  belong  to  the  group  of  Mycodermata. 

Each  crust  of  Tinea  is  described  by  M.  Gruby  to  consist  of  two  envelopes, 
formed  by  the  cuticle,  and  an  aggregation  of  Mycodermata,  which  are  inclosed 
within  them  like  fruit  in  their  pericarps.  The  crusts  are  placed  on  the  surface 
of  the  true  skin,  and  the  Mycodermata  are  developed  among  the  cells  of  the  epi- 
dermis. 

The  external  disc  of  the  capsule,  which  at  the  commencement  is  not  perfora- 
ted, becomes  open  in  the  centre  by  a  small  hole,  whose  borders  are  elevated,  by 
the  continual  development  of  the  Mycodermata.  This  opening  enlarges  by 
degrees,  and  there  is  thus  formed  in  the  centre  a  whitish  excavation,  whilst  the 
borders  remain  of  a  yellowish  colour.  Simultaneously  with  the  enlargement  of 
the  opening,  the  Mycodermata  protrude,  and  are  developed  like  a  fungus,  and 
finally  the  borders  disappear;  the  stems  of  the  Mycodermata  are  prolonged,  and 
the  sporules  shoot  out  vigorously,  more  in  the  centre  than  at  the  periphery.  From 
this  mode  of  growth,  the  form  of  the  crust  becomes  quite  altered,  it  being,  when 
completely  developed,  convex,  instead  of  concave  on  the  outer  surface. 

M.  Gruby  practised  inoculation  with  the  contents  of  these  crusts  upon  thirty 
phanerogamous  plants  (but  succeeded  only  once);  on  twenty-four  silk-worms; 
four  birds:  eight  mammals;  and  six  reptiles,  without  any  result.  Similar  inocu- 
lation in  the  arm  of  himself  four  times,  and  of  another  individual  once,  was 
followed  also  by  no  result,  except  in  one  instance,  when  a  little  inflammation 
ensued.  Consequently,  out  of  seventy-seven  inoculations,  one  successful  result 
only  was  obtained,  and  that  on  a  phanerogamous  plant— a  strange  fact,  as  is 
truly  observed  by  M.  Gruby. 

On  the  1st  of  March  1841,  Mr.  Westwood  exhibited  at  the  Entomological 

*  Mullet's  Archives. 

t  Medicinisch.  Zeitung,  No.  xvi.  pp.  73,  74. 

\  Valentin's  Repertorium,  1841.  §  Comptes  Rendus,  1841. 

II  Icones  fungorum  hucusque  cognitorum.     A.  C.  J.  Corda,  Pragse,  1837,  1840. 


1842. J  Anatomy  and  Physiology,  163 

Society,  dried  specimens  of  Chinese  larvae,  from  the  back  of  the  neck  of  each 
of  which  a  slender  fungus,  twice  as  large  as  the  body  of  the  insect,  had  been 
produced.  The  vegetation  was  stated  to  be  analogous  to  some  pn  larvae  from 
New  Zealand,  and  is  named  Clavaria  Entomorhiza.^  M.  Corda  gives  the  figure 
of  a  coleopterous  insectf  covered  with  Fenicillium  Fieberi;  and  a  similar  instance 
of  the  growth  of  a  minute  conferva  upon  the  body  of  a  Dytiscus  marginalis,  oc- 
curred a  short  time  since  to  my  observation.  This  insect  was  kept  in  a  glass 
vessel,  in  which  were  growing  some  plants  of  Valisneria  spiralis,  the  leaves  of 
which  were  much  infested  with  the  conferva.  The  beetle  was  killed,  apparently 
by  the  growth  of  conferva  among  the  branched  hairs,  with  which  its  spiracula 
are  furnished  internally. it: 

These  are  the  principal  facts  which  I  have  been  able  to  collect  on  this  subject; 
for  it  is  scarcely  worth  while  to  refer  to  the  vague  speculations  of  M.  Meynier 
of  Orleans,  whose  assertion  of  the  analogy  of  warts  and  similar  growths,  with 
Fungi  of  the  order  Gymnospermia;  of  Lepra  and  Psoriasis  with  Lichens  and 
Mosses;  and  of  pulmonary  tubercle  with  Lycoperdon,  may,  I  think,  justly  be 
considered  more  the  fruit  of  a  heated  imagination  than  of  sure  observation.  The 
Mucores  observed  by  Langenbeck  in  the  body  of  a  person  dead  of  typhus,  had 
certainly  no  connection  with  that  disease:  and  as  for  the  opinion,  that  hospital 
gangrene  is  dependent  on  the  presence  of  a  fungoid  growth,  I  am  unable  to  refer 
to  the  authority,  upon  which  such  a  doubtful  statement  is  founded. 

The  above  briefly  recited  facts  are  far  too  few  in  number,  and  not  sufficiently 
precise,  to  allow  of  any  general  deductions  of  importance  to  be  drawn  from 
them;  but  it  appears  clear, 

1.  That  parasitical  growths  occur  in  nearly  all  classes  of  the  animal  kingdom. 

2.  That  these  growths  arise  usually  on  the  surfaces  of  animal  organs,  and  are 
sometimes  prolonged  thence  into  the  textures  of  the  part. 

3.  That  they  have  in  several  instances  been  ascertained  to  constitute  the  cause 
of  disease  and  death;  and  that  the  disease  thus  produced  has  been  found  in  some 
cases  to  be  contagious. 

4.  That  they  are  probably  of  two  kinds,  the  one  peculiar  to  animal  bodies, 
and  the  other  consisting  of  those  cryptogamic  vegetations,  which  readily  sprout 
up  under  favourable  circumstances,  on  almost  any  inanimate  substance. 

To  the  former  kind  may  be  referred  the  Muse ardine  oi  the  silk-worm  and  Myco- 
derm  of  Tinea;  and  to  the  latter,  most  of  the  other  growths  above  alluded  to.§ 

The  vegetable  nature  of  these  growths  does  not  in  all  cases  appear  so  clear 
as  might  be  supposed.  In  some  of  the  instances  cited  above,  there  can  be  no 
doubt  on  the  matter;  but  in  others,  and  especially  that  of  the  Mycoderm,  consti- 
tuting the  crusts  of  Tinea,  it  is  allowable  to  doubt  whether  the  growth  may  not 
be  more  properly  referred  to  the  animal  kingdom.  In  fact,  it  would  appear, 
from  the  chemical  constituents  of  these  crusts,  impossible  to  hesitate  in  ascrib- 
ing their  contents  to  that  division  of  animated  nature;  for  according  to  the  analy- 
sis of  Thenard,  they  contained 

70  Albumen. 
17  Gelatine. 
5  Phosphate  of  Lime. 
8  Water  and  Loss. 

100 

*  Annals  of  Natural  History  for  November,  1841. 

t  Pentatorna  prasina,  op.  cit.  Pi.  xi. 

t  [We  are  informed  by  Mr.  J.  T.  Cooper,  that  he  has  frequently  removed  from  the 
gills  of  gold  fish,  kept  in  a  cistern  in  his  garden,  a  quantity  of  confervse,  the  rapid 
growth  of  which  over  the  whole  surface  of  their  bodies,  in  every  instance  caused 
death. — Editor.] 

§  With  the  exception  of  the  parroquet,  whose  case  is  related  by  M.  Rousseau  and 
M.  Serrurier,  in  which,  in  the  account  given  by  these  observers,  the  seat  of  the  para- 
sitic growth  is  by  no  means  clearly  defined,  it  would  appear  that  these  parasitic  growths 
have  nearly  all  had  some  relation  to  the  air-passages,  and  in  this  point  of  view  it  is  in- 
teresting to  refer  to  the  account  of  Chrysomyza  Abietis,  at  p,  155  of  this  Journal. 


164  Progress  of  the  Medical  Sciences,  U^^Y 

a  composition  certainly  more  animal  than  vegetable.  With  regard  to  this,  also, 
it  is  interesting  to  refer  to  the  paper  of  M.  J.  B.  Desmazieres,*  in  which  the 
genus  Mycoderma,  founded  by  Persoon  in  1822,  is  for  the  first  time  accurately  de- 
scribed and  figured.  He  describes  five  species  occurring  in  various  vegetable  infu- 
sions. The  marked  similarity  of  the  figures  of  some  of  these  species,  with  the 
Mycoderm  of  Tinea,  is  sufficiently  curious,  viz.  those  of  M.  glutinis  farinulas 
and  M.  cerevisias,  or  those  occurring  in  flour-paste  or  sour  beer.  M.  D.,  whose 
paper  is  well  vrorthy  of  perusal,  considers,  from  his  having  observed  the  glo- 
bules of  the  Mycodermata  occasionally  in  active  motion,  that  they  are  of  animal 
nature,  and  gives  the  following  definition  of  the  genus.- — Mycoderma. — Desmaz, 
Jinn.  Sc.  Nat.  Tom.  X.  le  Ser.  p.  59. — "  Animaleula  monadina  simplicissima, 
hyalina,  gelatinosa,  minutissima,  praedita  locomobilitate  plusminusve  manifesta; 
inter  se  ab  uno  extremo  ad  alterius  extremum  ordine  longo  cohserentia,  sive  in 
statu  primordiali,  sive  post  elongationem  plus  minusve  notabilem;  efFormantia, 
hac  adjunctione  fila  inertia  hyalina,  creberrima,  ramosa,  moniliformia,  vel  dis- 
sepimentis  conspicua,  fere  semper  incumbentia  liquoribus,  vet  substantiis  humi- 
dis  in  quibus  nascuntur  et  ubi,  per  eorum,  implicationem,  constituunt  pelliculam 
plus  minusve  spissam.     Generatio  per  gemmas  interiores." 

The  resemblance  in  figure,  however,  of  this  parasite  to  various  growths,  in  all 
probability  vegetable,  is  equally  striking,  if  we  do  not  consider  that  all  growths 
composed  of  distinct  rounded  cells,  whether  of  animal  or  vegetable  nature,  will 
necessarily  much  resemble  each  other.  For  instances  of  this  resemblance,  it  is 
only  necessary  to  refer  generally  to  the  plates  in  M.  Corda's  work,f  and  parti- 
cularly to  the  figures  of  Gonatorhodon  speciosa;  the  extreme  filaments  of  stysa- 
nus  Caput  Medusas;  Torula  tritici;  Torula  olivacea;  Torula  frutigena;  and 
several  others. 

The  description  of  the  Mycoderm  of  Tinea,  by  M.  Gruby,  above  referred  to, 
so  accurately  corresponds  with  the  observations  I  have  myself  been  enabled  to 
make  very  lately,  that  I  have  thought  the  addition  of  a  few  figures  of  the  ap- 
pearance presented  by  this  parasitic  growth  under  the  microscope,  would  be 
sufficient  to  prove  the  truth  of  the  position,  that  the  disease  does  in  reality  con- 
sist of  such  a  growth,  and  that  this  growth  corresponds  in  every  respect  with 
the  characters  of  Persoon's  genus,  Mycoderma.  I  have  not,  however,  been  able 
to  perceive  any  movement  in  the  globules  themselves,  as  appears  by  M.  Desma- 
zieres' observations,  to  have  been  the  case  in  other  species  of  this  genus.  There 
is,  however^  always  to  be  observed  in  the  fluid  with  which  the  Mycodermata 
may  be  mixed,  a  great  number  of  actively  moving  molecules  or  minute  infusoria. 

This  Mycoderm  is  readily  seen  by  placing  a  fragment  of  a  crust  of  Forrigo, 
moistened  with  water,  between  two  glasses.  The  younger  crusts  present  many 
of  the  small  branched  filaments  and  separate  corpuscles;  the  larger  crusts  con- 
tain more  of  the  beaded  filaments,  and  in  all,  the  Mycodermata  are  found  mixed 
with  epidermis  scales. — Microscopic  Journal^  December,  1841. 

7.  Dentition  of  Children  at  the  Breast,  By  Professor  Trousseau. — Suspect- 
ing that  the  generally  received  ideas  on  the  dentition  of  children  were  not  cor- 
rect, M.  Trousseau,  from  statistical  observations  not  very  numerous,  has  come  to 
conclusions  slightly  different  from  the  opinions  generally  believed. 

Period  at  which  the  first  tooth  appears.  This  has  been  determined  in  25 
children;  13  boys,  and  12  girls.     It  appeared  as  follows: 

In  2  boys  at    3  months.  In  1  girl  at  3  months. 

2           at    4  2         at  3 

2            at    5  1          at  4 

2           at    6  1          at  5 

2            at  10  3         at  6 

*  "Recherehes  Microscopiques  et  Physiologiques  sur  le  genus  Mycoderme." — An- 
nales  des  Sciences  Naturelles,  torn.  x.  Ife.  Ser.  1826. 

t  Fracht-Flora  Europgeischer  Schimmelbildungen,  Leipzig,  1839. 


1842.]  Anatomy  and  Physiology.  165 

In  2  boys  at  11  months.  In  1  girl  at    7  months. 

2  at  14  3         at    9 

1  at  14 

Extremes,  3  months,  14  months.  2  months,  14  months. 

Average,  7  months.  6  months. 

The  average  time,  then,  at  which  the  first  tooth  appears  is,  from  these  results, 
six  months  and  a  half;  while  the  generalbelief  at  present  is,  that  at  eight  months 
it  makes  its  appearance.  The  common  opinion  that  little  girls  are  more  pre- 
cocious than  boys,  is  also  corroborated,  as  we  find  a  difference  of  a  month  be- 
tween the  appearance  of  the  first  tooth  in  boys  and  in  girls. 

The  first  tooth  is  in  general  one  of  the  middle  inferior  incisors.  Of  twenty- 
eight  children  this  was  the  case  in  twenty-five.  In  two,  a  middle  superior  in- 
cisor appeared  first;  and  in  a  little  girl,  the  first  molars  preceded  all  the  others. 

Period  at  which  the  second  tooth  appears.  The  twenty-five  children  in  whom  a 
middle  inferior  incisor  first  showed,  had  for  their  second  tooth,  the  other  middle 
inferior  incisor.  The  common  opinion  is,  that  this  second  tooth  appears  almost  at 
the  same  time  as  the  first;  and  it  is  quite  correct.  In  twenty-five  children,  the  time 
that  elapsed  between  the  first  and  second  tooth,  was,  1  day  in  4  children;  2  days 
in  2  children;  3  days  in  I  child;  8  days  in  3  children;  15  days  in  7  children;  30 
days  in  one  child;  90  days  in  1  child.  In  six  the  time  could  not  be  determined 
by  the  mother. 

The  middle  superior  incisors  appear  next  after  the  two  middle  inferior.  In 
eighteen  children,  fifteen  had  these  teeth  after  the  middle  inferior  incisors.  The 
time  that  elapses  generally  between  the  cutting  of  the  inferior  and  superior  in- 
cisors, is  more  variable  than  is  generally  supposed.  In  thirteen  children  in 
whom  M.  Trousseau  was  able  to  verify  this,  there  was  a  lapse  of  8  days  in  2 
children;  1  month  in  3  children;  2  months  in  3  children;  3  months  in  one  child; 
4  months  in  1  child;  5  months  in  2  children;  10  months  in  1  child. 

In  general,  then,  there  is  a  considerable  interval  between  the  appearance  of 
the  second  first  and  the  second  second  teeth.  It  maybe  established  as  a  general 
rule,  almost  without  any  exception,  that  after  the  appearance  of  these  four  teeth, 
the  two  lateral  superior  incisors  next  cut  the  gum,  and  then  the  two  inferior  ones, 
so  that  the  child  has  only  two  teeth  in  the  lower  jaw,  while  it  has  four  in  the 
upper.  It  is  curious,  M.  Trousseau  says,  that  this  fact,  so  well  known  to 
mothers  who  have  brought  up  several  children,  should  be  unknown  to  those 
who  have  written  specially  on  the  subject.  Whilst  a  considerable  period  takes 
place  between  the  first  appearance  of  the  inferior  and  superior  incisors,  the  four 
superior  incisors  follow  each  other  at  a  short  interval.  After  these  six  teeth 
have  come  through,  some  time  elapses  before  the  next,  which  are  generally  be- 
lieved to  be  the  two  lateral  inferior  incisors,  appear.  M.  Trousseau,  however, 
says,  that  as  a  general  rule,  one  or  several  molars,  and  sometimes  even  the  ca- 
nine, are  protruded  before  them.  After  the  cutting  of  the  four  molars,  and  the 
two  inferior  lateral  incisors,  another  considerable  interval  of  time  elapses,  when 
the  four  canine  successively  appear;  and  then  after  another  period,  at  the  age  of 
from  twenty-four  to  thirty  months,  rarely  sooner,  the  second  set  of  molars  come 
out. 

In  the  second  part  of  his  work,  M.  Trousseau  treats  of  the  diseases  incidental 
to  teething,  and  especially  of  the  diarrhosa  accompanying  it,  and  he  combats  the 
opinion  so  prevalent,  that  nothing  ought  to  be  done  for  it.  He  shows  that  it  is 
not  only  not  useful,  but  decidedly  injurious  to  the  little  patients — that  it  weakens 
them,  and  lays  the  foundation  of  marasmus,  which  if  not  checked  in  time,  soon 
goes  on  to  a  fatal  termination. — Lond.  and Edin,  Monthly  Journ,  Med,  Set,.,  May, 
1842,  from  Gaz.  Med.  de  Paris,  4lh  Feb,  1843, 


Progress  of  the  Medical  Sciences,  U^^Y 


MATERIA  MEDICA  AND  PHARMACY. 

8.  Styptic  effect  of  Kreasote. — A  robust  countryman  divided  the  ulnar  artery 
with  a  sharp  knife,  the  consequence  of  which  was  repeated  bleedings,  which, 
however,  were  staunched  by  surgical  aid.  Three  weeks  afterwards,  hemor- 
rhage returned,  and  Dr.  Burdach  of  Luckan  was  sent  for.  He  found  the  wound, 
which  at  first  was  a  simple  puncture,  livid  at  the  edges,  and  expanded  to  the 
size  of  the  palm  of  the  hand,  by  a  spongy  growth  from  the  bottom.  This  spongy 
mass  was  in  a  gangrenous  condition,  and  prevented  the  examination  of  the 
wound;  the  arm  was  swollen  from  the  shoulder  to  the  finger  points;  it  could  not 
be  moved,  and  was  excessively  painful.  Dr.  Burdach  had  only  the  choice  be- 
tween actual  cautery  and  kreasote  left,  for  in  such  a  state  of  the  arm,  tying  the 
artery  was  out  of  the  question.  He  poured  ^ss  of  kreasote  {freed from  eupion) 
into  the  wound.  This  gave  the  patient  no  pain;  nay,  after  it  he  enjoyed  refresh- 
ing sleep  for  the  first  time  since  the  accident.  There  was  no  more  hemorrhage; 
the  pouring  in  of  the  kreasote  was  repeated  morning  and  evening,  and  the  spongy 
mass  gradually  diminished,  and  three  days  afterwards,  under  the  co-operating 
influence  of  bandages  moistened  with  kreasote,  ol.  tereb.  and  balsam,  indie, 
loosened  itself  from  the  bottom  of  the  wound.  The  divided  artery  was  no  more 
visible,  the  swelling  of  the  arm  decreased,  and  the  complete  cure  shortly  followed 
without  any  relapse. — Lond.  and  Edin.  Monthly  Journ.  Med.  Set.  May  1842,  from 
Medicinische  Zeittmg,  Jahrg.  1840.  No.  31. 

9.  Sulpho-Cyanuret  of  Potassium, — This  salt,  a  most  valuable  re-agent  for 
the  salts  of  iron,  has  been  recommended  by  Soemmering  to  replace  in  medicine 
the  hydrocyanic  acid  and  the  cyanuret  of  potassium,  the  therapeutic  properties 
of  which  it  possesses  without  their  inconveniences.  M.  Meillet  employs  the 
following  plan  for  its  preparation,  which  is  cheaper  than  that  in  whicii  alcohol 
is  used.  The  mixture  of  dry  prussiate  of  potass  and  sulphur  is  introduced  into 
a  Hessian  crucible,  and  heated  to  the  state  of  pasty  fusion;  it  is  then  stirred  with 
an  iron  rod,  and  withdrawn  from  the  fire.  When  the  crucible  is  cold,  wash  the 
mixture  with  water  instead  of  alcohol,  and  filter;  and  a  liquid,  charged  with  the 
sulpho-cyanuret  of  potassium,  and  a  little  sulpho-cyanuret  of  iron,  will  be  ob- 
tained. The  iron  is  precipitated  by  means  of  the  carbonate  of  potass,  the  fluid 
is  poured  off,  and  if  it  be  alkaline,  saturated  with  a  little  nitric  acid.  It  is  then 
evaporated  and  crystallised  frequently;  the  acetate  of  potass  remains  in  the 
mother  waters.  If  the  mixture  be  heated,  as  some  authors  advise,  beyond  pasty 
fusion,  to  a  dull  red,  a  large  quantity  of  the  sulpho-cyanuret  of  potassium  is  de- 
composed, and  a  notable  quantity  of  carbonate  of  potass  produced.  It  is  better 
to  have  in  the  liquid  a  sulpho-cyanuret  of  iron,  which  can  be  changed  into  the 
sulpho-cyanuret  of  potassium,  than  potass,  which  is  a  real  loss.  If  the  fire  has 
been  too  strong,  and  that  is  most  frequently  the  case,  in  washing  the  matter  with 
water  we  obtain  a  sulpho-cyanuret  of  potassium  with  the  carbonate  of  potass. 
As  boiling  alkaline  solutions  decompose  the  sulpho-cyanuret  into  sulphuret  of 
potassium,  carbon  which  is  deposited,  and  azote  which  is  disengaged,  the  alco- 
hol was  employed  to  isolate  the  carbonate  insoluble  in  that  menstruum.  In  that 
case  it  is  advisable  to  add  a  few  drops  of  v^hite  pyroligneous  acid  to  saturate 
the  free  alkali;  the  liquid  is  then  evaporated,  and  set  to  crystallize. — Prov.  Med. 
and  Surg.  Journ.  May  14,  1842,  (rota  Journ.  de  Pharmacie. 

10.  Lime  Moxa. — Lime  has  been  employed  by  Dr.  Osborne  as  a  moxa. 

It  is  used  as  follows:  A  little  quicklime,  to  the  depth  of  half  an  inch,  is  put 
within  a  porte  moxa^  or  a  circular  piece  of  card,  and  applied  to  the  skin;  water 
is  then  dropped  on  it,  and  mixed.  In  about  two  minutes  it  swells,  and  an  in- 
tense heat  is  given  out.  It  has  been  calculated  that  the  heat  produced  is  equal 
to  500°  of  Fahrenheit.  If  it  is  kept  on  as  long  as  the  heat  continues,  the  whole 
skin  is  destroyed;   but  by  removing  it  sooner,  an  issue  to  any  extent  may  be 


1842.]  Medical  Pathology  and  Therapeutics,  167 

formed.  Dr.  0.  prefers  this  kind  of  moxa,  from  the  great  heat  suddenly  pro- 
duced, and  from  no  fire  or  sparks  being  seen,  so  as  to  alarm  the  patient.  To 
ascertain  the  depth  to  which  this  moxa  acts,  he  applies  it  to  the  surface  of  an 
egg,  and  then  observes  the  thickness  of  coagulated  albumen  formed  beneath. 
The  size  of  the  ulcer  formed  is  always  twice  as  large  as  that  of  the  lime  applied. 
When  the  lime  is  prepared  from  calcareous  spar,  the  heat  produced  on  the  addi- 
tion of  the  water  is  sudden  and  intense,  and  the  pain  is  proportionately  urgent. 
For  ordinary  purposes,  however,  well-selected  pieces  of  lime,  from  a  limekiln^^ 
answer  well  \i  fresh,  but  not  otherwise. — Lond.  and  Edin.  Monthly  Journ.  Med, 
Sci.,  March,  1842. 


MEDICAL  Px\THOLOGY,  THERAPEUTICS,  AND  PRACTICAL 

MEDICINE. 

11.  Five  cases  of  Crowing  Inspiration  of  Children  in  the  same  family.  By 
Jonathan  Toogood,  Esq. — Case  I. — H.  I.,  when  about  a  year  old,  was  suddenly 
seized,  without  any  previous  indisposition,  with  the  following  symptoms: — A 
slight  crowing  noise  was  first  observed,  a  feeble  distressing  cry  was  uttered, 
followed  by  a  sudden  suspension  of  breathing  and  threatening  of  instant  suflfo- 
cation;  the  countenance  became  livid,  the  eyes  starting  from  their  sockets,  frothy 
saliva  was  protruded  from  the  mouth,  the  jaw  fell,  and  he  remained  so  long  in 
this  state  that  the  bystanders  thought  he  was  dead.  He  was  laid  in  a  horizon- 
tal position  and  kept  perfectly  still,  when,  after  a  few  minutes,  a  slight  attempt 
at  inspiration  was  made,  which  gradually  improved,  until  his  complete  recovery 
was  established.  The  contents  of  the  bladder  and  rectum  were  evacuated 
during  the  attack;  his  countenance  was  very  pale  for  a  long  time  afterwards. 
During  the  next  six  months  he  had  several  slight  attacks,  which  almost  inva- 
riably commenced  during  comfortable  easy  sleep,  and  were  preceded  by  an  ex- 
pression of  pain  in  the  countenance,  and,  although  of  short  duration,  were  very 
distressing.  After  this  time  they  ceased  entirely,  and  he  has  grown  up  to  man- 
hood in  the  enjoyment  of  good  health. 

Case  II. — F.  I.,  his  brother,  was  attacked  in  the  same  manner  when  about 
six  weeks  old,  and  after  repeated  seizures,  suddenly  expired  in  one  when  four- 
teen weeks  old. 

Case  III. — 0.  I.,  another  brother,  had  a  similar  attack  when  about  a  year  and 
a  half  old,  but  less  violent.  These  recurred  occasionally  until  he  was  three 
years  old,  when  they  ceased.     He  has  grown  up  to  manhood  in  good  health. 

Case  IV. — A.  I.,  another  brother,  began  to  have  the  same  affection  when 
about  six  months  old,  which  continued  until  he  completed  his  fourth  year.  Dur- 
ing this  period  the  attacks  were  sometimes  so  violent  as  to  threaten  instant 
death.  They  were  occasioned  by  crying  or  passion,  and  once  in  consequence 
of  a  fall,  which  brought  on  so  violent  a  seizure,  that  there  appeared  no  proba- 
bility of  his  recovery.  He  was  kept  perfectly  still,  with  his  head  a  little 
raised,  and  after  two  or  three  minutes  he  began  to  breathe  again.  After  this  he 
had  slight  attacks  on  crying  or  losing  his  breath,  but  never  a  serious  one;  the 
countenance  always  became  livid,  and  respiration  was  suspended,  but  there  was 
no  convulsion,  which  invariably  happened  when  the  attack  w^as  severe. 

Case  V.— M.  A.,  a  sister,  a  delicate  child,  born  at  eight  months,  was  very 
well  until  six  months,  when  she  was  seized  exactly  as  her  brothers  had  been, 
without  any  previous  indisposition.  These  attacks  recurred  frequently  until  the 
end  of  May,  after  which  time  she  had  slight  ones.  Convulsions,  lividity  of  the 
countenance,  and  evacuation  of  the  contents  of  the  rectum  and  bladder,  always 
accompanied  the  attacks.  On  one  occasion  she  lay  apparently  dead,  when  the 
lungs  were  inflated,  to  which  her  recovery  was  attributed.  In  the  month  of 
June,  when  three  quarters  of  a  year  old,  the  bones  of  the  head,  which  had  closed 
as  firmly  as  usual  at  that  period,  except  the  interior  fontanelle,  separated  again, 
and  the  division  of  the  sutures  could  be  easily  traced  with  the  finger.     After 


168  Progress  of  the  Medical  Sciences,         .  [July 

this  she  appeared  to  get  much  better,  and  the  spine,  which  seemed  inclined  to 
bend  before,  became  strongs,  and  although  she  occasionally  made  a  croupy  noise, 
and  had  very  slight  attacks  of  lividity  of  the  countenance,  and  temporary  sus- 
pension of  the  breathing  if  she  cried  much,  there  was  no  severe  symptom  or  con- 
vulsion. She  continued  pretty  well  until  the  3rd  of  April  following,  and  was  a 
remarkably  active,  sprightly  child,  had  eight  teeth,  and  was  then  cutting  the 
eye  teeth.  Whilst  asleep  in  the  garden  she  was  suddenly  attacked,  as  formerly, 
but  soon  recovered.  This  was  supposed  to  arise  from  teething,  and  the  gums 
were  freely  divided  immediately.  She  now  began  to  show  symptoms  of  hoop- 
ing-cough, and  was  often  unwell,  making  a  slight  croupy  noise,  which,  however, 
did  not  appear  to  hurt  her,  as  she  often  laughed  before  it  was  scarcely  over. 
Her  nurse  thought  it  a  trick.  She  appeared  to  be  going  through  the  disease 
favourably,  but  on  Tuesday  night  did  not  sleep  as  well  as  usual,  from  more  fre- 
quent fits  of  coughing,  and  was  irritable  the  next  day,  scratching  those  about  her 
on  the  slightest  cause.  On  the  following  day  (Wednesday)  she  had  another 
slight  attack.  Her  bowels  having  been  carefully  attended  to,  and  the  cough 
having  been  more  troublesome  during  the  night,  some  ipecacuanha  wine  was 
given  at  eleven  o'clock  on  Thursday  morning,  which  operated  well.  At  one, 
whilst  lying  in  the  nurse's  lap,  she  had  a  most  violent  attack,  and  was,  for  some 
time,  believed  to  be  dead,  but  after  pouring  an  ounce  and  a  half  of  brandy  and 
water  down  her  throat,  she  slowly,  and  with  great  difficulty,  recovered.  This 
was  followed  by  convulsion  and  long  continued  spasm  of  the  muscles,  so  that 
the  body  was  quite  rigid  and  could  not  be  bent,  although  kept  for  a  considerable 
time  in  a  warm  bath.  She  appeared  to  suffer  great  pain  for  two  hours,  after 
which  she  became  easier,  and  remained  so  till  seven  o'clock,  when  the  spasms 
returned  with  equal  violence,  and  recurred  every  two  minutes,  affecting  the  right 
side  chiefly,  until  five  o'clock  the  next  morning.  No  relief  was  obtained  from 
the  application  of  leeches,  warm  bath,  the  warm  water  injection,  or  lancing  the 
gums.  About  eight  o'clock  she  screamed  violently,  but  she  was  sensible  and 
took  nourishment  several  times.  At  ten  the  spasms  returned,  butwith  less  vio- 
lence, but  they  continued  with  little  variation  during  the  whole  of  Friday  and 
until  Sunday  morning,  when  she  appeared  to  get  somewhat  easier,  and  although 
she  was  less  drawn,  and  the  dreadful  grinding  of  the  teeth  had  subsided,  there 
was  still  a  constant  frowning  and  knitting  of  the  brows,  denoting  great  pain. 
She  appeared  sensible  during  the  greater  part  of  Sunday,  took  food  occasionally, 
and  slept  a  good  deal,  but  it  was  doubtful  whether  she  saw  distinctly;  there 
was  no  squinting.  On  Sunday  night  she  became  affected  with  spasmodic 
twitchings  of  the  muscles,  and  was  sometimes  harassed  with  cough.  She  had 
a  repetition  of  her  former  attacks  at  four  in  the  morning,  and  again  at  ten,  from 
which,  however,  she  soon  recovered.  Another  fit  recurred  at  twelve  o'clock, 
whilst  lying  perfectly  quiet,  in  which  she  expired. 

The  body  was  examined  early  on  the  following  morning.  It  was  not  emacia- 
ted. Upon  the  removal  of  the  pericranium,  the  skull-cap  presented  a  natural 
appearance,  the  fontanelle  not  beiHg  perfectly  closed  by  ossification.  It  required 
more  than  the  usual  degree  of  force  to  tear  off  the  skull-cap  from  the  dura  mater, 
and  when  this  was  effected,  it  was  found  that  a  large  portion  of  the  membrane 
adhered  to  the  right  parietal  bone.  The  veins  were  turgid  with  blood.  Between 
the  arachnoid  membrane  and  the  pia  mater,  a  substance  of  a  gelatinous  nature, 
rather  hazy  or  milky  in  colour,  was  diffused  nearly  over  the  whole  surface. 
Some  fluid  escaped  from  the  surface  of  the  brain,  but  the  quantity  could  not  be 
ascertained.  Upon  cutting  into  the  lateral  ventricles,  they  were  found  to  be 
distended  with  fluid,  as  was  also  the  communication  between  these  and  the 
third  ventricle,  which,  as  well  as  the  iter  ad  infundibulum,  and  the  iter  a  tertio 
ad  quartum  ventriculum,  was  also  distended  with  fluid.  There  was  also  much 
fluid  at  the  base  of  the  brain  and  in  the  fourth  ventricle.  The  whole  quantity 
amounted  to  about  four  ounces.  The  substance  of  the  brain  was  softer  than 
natural.  The  viscera  of  the  chest  and  abdomen  were  healthy.  No  glandular 
affection  could  be  detected  in  any  of  these  cases. — Prov.  Med,  and  Surg.  Journ.- 
May  7,  1842. 


1842.]  Medical  Patliology  and  Therapeutics,  16^ 

12.  Case  of  enlarged  Thymus  Gland,  producing  spasm  of  Glottis  hy  compress- 
ing  the  recurrent  Nerves.     By  Thomas  Mitchell,  M.  D.,  of  Dublin. — About 

4  o'clock  A.  M.  16th  Deo.  1841,  I  was  sent  for  to  see  the  infant  of  Mr. , 

four  months  old,  whom  the  messenger  informed  me  was  labouring  under  croup. 
On  my  arrival,  I  found  the  child  lying  across  the  nurse's  knees,  apparently  much 
exhausted;  the  breathing  quick  and  hurried,  with  a  slight  lividity  of  the  face 
and  lips;  on  making  inquiry,  I  ascertained  that  the  child  had  been  in  good 
health  (if  a  slight  diarrhoea  be  excepted),  for  some  time  previous,  that  about 
twelve  o'clock  at  night,  it  appeared  restless  and  uneasy,  starting  from  its  sleep, 
and  crying,  which  was  thought  to  be  owing  to  the  disturbed  state  of  its  bowels. 
Some  carminative  medicine  was  administered,  and  it  fell  asleep. 

About  three  o'clock,  however,  it  awoke  crying;  the  breathing  became  labo- 
rious, and  hurried,  attended  with  a  peculiar  shrill  sound  during  inspiration, 
which  gave  rise  to  the  opinion  that  it  was  croup;  this  symptom  had  disappeared 
before  my  arrival. 

As  the  only  symptoms  of  urgency  appeared  to  arise  from  the  respiratory 
organs,  I  treated  it  as  an  attack  of  bronchitis,  which  at  ihe  time  was  very  preva- 
lent amongst  infants.  It  was  put  immediately  into  a  warm  bath,  which  pro- 
duced the  most  decided  benefit,  the  difficulty  of  breathing  was  relieved,  and  it 
fell  into  a  quiet  sleep.  I  ordered  a  mercurial  purgative  to  be  given,  and  a  mix- 
ture, containing  tartar  emetic,  every  15  minutes,  and  after  remaining  some  time, 
during  which  it  appeared  quite  easy,  I  left  the  house  expecting  to  find  it  much 
better  on  my  next  visit.     Leeches  were  procured  but  were  not  applied. 

I  had  scarcely  reached  home  when  a  messenger  arrived  to  say  that  the  child 
had  had  a  well  marked  fit,  the  head  was  thrown  back,  the  extremities  extended 
and  with  the  entire  body  convulsed,  and  on  my  arrival  a  second  time  it  was 
dead. 

Dissection  twenty  hours  after  death. — Body  fat,  extremities  stiff,  considerable 
lividity  of  the  posterior  part  of  the  body,  and  left  side. 

On  opening  the  thorax  the  anterior  mediastinum  v/as  found  completely  filled 
with  the  thymus  gland  enormously  enlarged,  and  distended,  extending  laterally 
over  the  lungs,  (especially  the  right  lung),  which,  with  the  right  side  of  the 
heart  were  both  engorged  with  blood,  of  a  dark  colour.  On  continuing  the  dis- 
section up  the  neck  where  the  thymus  ascends  to  meet  with  the  thyroid  body, 
the  lobes  on  each  side  were  greatly  enlarged,  each  lobe  completely  surrounding 
the  recurrent  nerves,  numerous  large  blood-vessels  passed  into  it,  and  on  making 
a  section  of  it  a  quantity  of  dark  serous  like  fluid  escaped,  which  had  the  effect 
of  greatly  diminishing  its  size;  the  milky  fluid  described  by  some  authors  as 
being  found  in  its  centre  was  not  present. 

The  mouth,  larynx,  and  trachea,  were  quite  healthy  in  appearance,  with  the 
exception  of  a  slight  contraction  of  the  rima  glottidis,  which  in  all  probability 
had  been  much  more  constricted,  and  had  become  relaxed  from  the  length  of 
time  the  child  had  been  dead.  There  was  no  appearance  of  disease  in  any 
other  part  of  the  body.     The  head  was  not  opened. 

The  cause  of  death  in  this  case  was  so  evident,  that  I  think  it  would  be  use- 
less to  make  any  comments  upon  it,  neither  am  I  aware  that  any  method  of 
treatment  would  have  been  of  use. —Dublin  Medical  Fr ess,  March  9,  1842. 

13.  Identity  of  Cow-pox  and  Small-pox. — Dr.  Muhry  of  Hanover,  in  a  letter 
published  in  the  Frov.  Med.  and  Surg.  Jour.,  14th  May  1842,  states  that  Dr. 
Reiter  of  Bavaria,  "variolated  fifty  coVs,  and  once  succeeded  in  getting  a  pus- 
tule, the  matter  of  which  he  employed  on  a  child,  and  succeeded  here  likewise 
in  producing  pustules,  but  then,  alarmed  by  a  secondary  eruption  of  vesicles,  he 
took  the  disease  for  variola,  and  discontinued  the  propagation.  The  experi- 
ment was,  however,  as  it  were,  accidentally  continued,  and  afforded  a  most 
valuable  proof  of  the  identity.  The  cow  which  had  produced  the  pustule  stood 
in  the  same  stable  with  another,  and  the  latter  about  three  weeks  afterwards 
showed  excellent  cow-pox.  The  same  happened,  in  another  stable,  and  from 
both  these  infected  cows  children  were  inoculated,  and  showed  very  fine,  well 
No.  VII.— July,  1842.  15 


170  /        Progress  of  the  Medical  Sciences.  [July 

characterized  cow-pox.  This  observation,  though  not  taken  as  a  proof  by  the 
author  himself,  is  fully  entitled  to  be  added  to  the  experiments  of  Thiele  and 
Cely  in  favour  of  the  question. 

He  further  states,  that  Dr.  Gassnar,  in  1801,  inoculated  eleven  cows,  one  of 
which  only  became  affected  with  cow-pox,  and  with  the  lymph  from  this  cow 
Dr.  G.  inoculated  four  children  of  a  clergyman,  in  all  of  whom  a  pustule  was 
produced,  having  the  characters  of  genuine  cow-pox.  The  same  occurred  in 
seventeen  other  children,  when  he  lost  the  lymph  with  the  right  time  for  its 
further  propagation. 

14.  Vaccination  in  France  in  1840. — M.  Gauthier  de  Claubry,  in  the  annual 
report  for  1840,  states  that  the  number  of  vaccinations  amounted  to  525,509  in 
836,789  births,  or  to  five-eighths  of  the  whole  number  born.  Of  45,0G0  vacci- 
nations, the  results  of  which  were  mentioned,  881  failed.  In  two  cases,  there 
was  a  general  eruption  of  pustules  over  the  body,  the  fluid  from  which  produced 
regular  vaccinia. 

Epidemic  variola  attacked  14,470  persons,  of  whom  1,668  died;  in  24  cases 
small-pox  occurred  a  second  time,  and  three  of  those  thus  attacked  died.  The 
great  majority  of  persons,  whether  recently  or  for  a  long  time  vaccinated,  escaped 
epidemic  small-pox;  some  had  modified  small-pox,  which  was  generally  mild 
and  of  short  duration.  Of  406  persons  attacked  after  vaccination,  only  6  died. 
Revaccination  was  performed  in  2,214  cases;  1,704  failures;  227  false  vaccinia; 
270  secondary  cow-pox,  apparently  regular;  3  persons  who  had  been  successfully 
revaccinated  were  attacked  with  varioloid.  The  average  cost  of  vaccinating 
each  infant  during  the  year  1840  was  threepence  halfpenny. 

The  following  are  the  conclusions  of  the  report: — 

1.  The  regular  vaccine  is  a  preservative  against  small-pox;  the  protection,, 
however,  is  not  absolute;  for  a  small  number  of  those  vaccinated  are  subject  to 
an  eruption  commonly  known  under  the  name  of  varioloid. 

2.  The  latter  disease  is  generally  mild,  and  free  from  danger;  it  destroys  1 
patient  in  100,  while  the  mortality  of  small-pox  was  1  in  8^. 

3.  A  first  vaccination  destroys  the  tendency  to  a  second  attack  of  vaccinia  as 
well  as  of  small-pox;  still,  in  some  persons  the  aptitude  to  receive  the  disease 
returns  after  a  longer  or  shorter  period.  Again,  certain  persons  who  have  had 
small-pox  may  contract  a  regular  vaccine,  but  this  does  not  prove  that  they  are 
apt  to  iiave  small-pox  again. 

4.  The  most  perfect  revaccination  does  not  guarantee  the  individual  against 
having  a  varioloid  at  some  future  time. 

5.  In  general,  small-pox  attacks  persons  only  once;  but  some  may  have  it  a 
second  time,  and  the  second  attack  is  just  as  severe  as  the  first  one. — Prov» 
Med.  and  Surg.  Journ.,  May  14,  1842. 

15.  Sciatica  cured  by  Extract  of  Belladonna. — ^The  following  interesting  case 
is  related  in  the  Bulletin  Therapeutique. 

A  lieutenant  in  the  French  navy  had  long  laboured  under  a  very  severe  form 
of  sciatica;  the  pain  extended  from  the  sciatic  notch  to  the  terminal  branches  of 
the  nerve  in  the  foot,  and  was  of  the  most  violent  kind.  Several  remedies  had 
been  tried  without  effect,  when  M.  Hiriart  resolved  on  employing  the  extract  of 
belladonna.  The  bowels  were  first  cleared  out  by  an  active  purgative;  and  the 
whole  limb  was  then  rubbed,  several  times  during  the  day,  with  an  ointment 
composed  of  one  part  of  the  extract  to  two  of  lard.  After  the  fourth  friction  the 
patient  experienced  a  creeping  sensation  in  the  limb,  and  some  slight  symptoms 
of  narcotism  appeared;  he  enjoyed,  however,  some  sleep  during  the  night.  On 
the  following  morning  the  pain  had  shifted  to  the  opposite  limb,  whence  it  was 
driven  by  the  same  means.  The  state  of  the  bowels  and  stomach  was  regulated 
by  gentle  purgatives  and  proper  diet,  and  in  a  short  time  the  patient  was  com- 
pletely cured  of  a  disease  from  which  he  had  previously  suffered  the  most  cruel 
torments. — Frov,  Med.  and  Surg.  Journ.,  March  26,  1842. 


1842.]  Medical  Pathology  and  Therapeutics.  171 

16.  On  the  incipient  stage  of  Cancerous  Jlffections  of  the  Womb.  By  Dr.  W, 
F.  Montgomery. — In  this  paper  the  author  directs  the  attention  of  practitioners 
to  a  stage  of  cancer  uteri  which  precedes  the  two  usually  described  by  writers. 

The  symptoms  are — sharp  but  comparatively  fugitive  lancinating  pains  in  the 
back  and  loins,  across  the  supra-pubic  region,  or  shooting  along  the  front  of  the 
thigh,  or  sometimes  along  the  course  of  the  sciatic  nerve,  producing  numbness, 
and  not  unfrequently  debility  of  the  whole  limb. 

In  a  large  proportion  of  the  cases,  there  is  found  a  decided  fulness,  or  a  dis- 
tinct tumour  in  one  or  other  iliac  hollow,  with  fixed  pain,  and  tenderness 
traceable  to,  and,  as  it  were,  issuing  out  of  the  abdominal  ring;  there  is,  gene- 
rally, more  or  less  irritation  of  the  bladder,  with  dysuria,  and  the  patient  often 
complains  of  a  sensation  about  the  lower  part  of  the  rectum,  which  induces  her 
to  think  that  she  is  labouring  under  piles.  Menstruation,  though  in  some  in- 
stances disturbed,  is  much  more  frequently  quite  regular  in  its  returns;  but  there 
is  apt  to  be  bursts  of  hemorrhage,  either  accompanying  the  discharge,  or  occur- 
ring in  the  intervals;  there  is  little,  or  no  leucorrhceal  or  serous  discharge,  often 
none;  and  it  is  not  until  the  disease  has  existed  for  a  considerable  time,  that  the 
appetite  is  impaired,  sleep  is  disturbed,  the  flesh  becomes  softer  and  wastes,  and 
the  countenance  pale,  and  expressive  of  distress. 

On  making  examination />er  vaginam^  the  margin  of  the  os  uteri  is  found  hard, 
and  often  slightly  fissured,  and  projects  more  than  usual,  or  is  natural,  into  the 
vagina,  and  is  irregular  in  its  form. 

In  the  situation  of  the  muciparous  glands,  there  are  felt  several  small,  hard, 
and  distinctly  defined  projections,  almost  like  grains  of  shot,  or  gravel,  under 
the  mucous  membrane.  Pressure  on  these,  with  the  point  of  the  finger,  gives 
pain,  and  the  patient  often  complains  that  it  makes  her  stomach  feel  sick. 

The  cervix  is,  in  most  instances,  slightly  enlarged  and  harder  than  it  ought 
to  be.  The  circumference  of  the  os  uteri,  especially  between  the  projecting 
glandulse,  feels  turgid,  and  to  the  eye  presents  a  deep  crimson  colour,  while  the 
projecting  points  have  sometimes  a  bluish  hue. 

There  is  no  thickening,  or  other  alteration  of  structure  in  any  part  of  the 
vagina,  at  its  conjunction  with  which  the  cervix  uteri  moves  freely;  nor  is  there 
any  consolidation  of  the  uterus  with  the  neighbouring  contents  of  the  pelvis;  in 
fact,  the  morbid  organic  change  appears  to  be,  at  first,  entirely  confined  to  the 
OS  uteri  and  lower  portion  of  the  cervix. 

This  stage  of  the  affection  is,  in  many  instances,  very  slow,  lasting  sometimes, 
for  years,  before  the  second  and  hopeless  stage  is  established;  during  this  time 
the  patient  experiences  only  comparatively  slight  and  transient  attacks  of  pain, 
or  perhaps  only  sensations  of  uneasiness,  referred  often  to  the  situation  of  one 
or  other  of  the  ovaries,  or  about  the  os  uteri,  with  anomalous  tingling  along  the 
front  and  inside  of  the  thighs;  these  last  for  a  few  hours,  or  a  day  or  two,  and 
then  disappear,  perhaps  for  weeks;  but  again  and  again  return  in  the  same  situ- 
ation, and  for  a  long  time  are  not  increased  in  severity;  the  patient  finds  that 
sexual  intercourse  now,  occasionally,  causes  her  pain,  which  she  ascribes  to 
some  deep-seated  part  being  touched,  and  the  act  is  followed  by  an  appearance 
of  blood;  she  is,  also,  often  troubled  with  slight  irritability  of  the  bladder;  but 
the  appetite,  digestion,  and  sleep,  may,  for  a  long  time,  continue  good,  and  the 
pulse,  generally,  gives  no  indication  of  the  existing  disease,  or  its  changes;  an 
observation  which  will  be  found  applicable  to  many  uterine  affections  of  a  very 
grave  character;  in  short,  the  general  health  may  long  remain  quite  undisturbed, 
nor  has  the  patient,  in  many  instances,  the  slightest  suspicion  that  there  is  any- 
thing seriously  wrong  with  her,  nor  thinks  of  seeking  for  medical  aid,  until  she 
is  induced  to  do  so  by  the  solicitations  of  her  husband,  or  some  anxious  friend 
who  lias  become,  as  she  thinks,  unreasonably  alarmed  about  her  state. 

Dr.  Montgomery  thinks  that  the  first  discoverable  change  in  the  cases  now 
alluded  to  "takes  place  in  and  around"  the  muciparous  glandulae,  which  exist 
in  such  numbers  in  the  "  cervix  and  margin  of  the  os  uteri;"  these  become  indu- 
rated by  the  disposition  of  scirrhous  matter  around  them,  and  by  the  thickening 


172  Progress  of  the  Medical  Sciences,  U^^Y 

of  their  coats,  in  consequence  of  which  they  feel,  at  first,  almost  like  grains  of 
shot  or  gravel  under  the  mucous  membrane. 

Treatment. — In  almost  every  instance,  the  treatment  should  be  begun  by  the 
local  abstraction  of  blood,  either  by  cupping,  or  by  leeches  applied  directly  to  the 
OS  uteri,  or  as  near  as  possible  to  the  organ;  and  their  application  will,  in  most 
cases,  require  to  be  frequently  repeated,  and  should  be  accompanied  by  the  free 
use  of  anodyne  fomentations.  Venesection  is  not,  in  general,  required.  Except 
there  be  something  specially  to  forbid  its  use,  mercury  should  be  given,  in  some 
form,  so  as  to  bring  the  system  very  gently,  but  decidedly,  under  its  influence; 
for  which  purpose  it  may  be  combined  with  iodine  in  very  minute  proportions, 
with  camphor,  opium,  hyoscyamus,  or  hemlock;  and  occasionally  by  friction, 
especially  where  there  exists  evidence  of  inflammatory  action  in  the  iliac  hol- 
low, as  already  adverted  to. 

Afterwards,  iodine  or  hydriodate  of  potash  may  be  used  both  internally  and 
externally;  and  iron  will  be  found  a  most  beneficial  and  powerful  agent,  espe- 
cially in  the  form  of  the  saccharine  carbonate,  or  the  carbonate  given  in  the  nas- 
cent state.  The  iodide  of  iron,  which  combines,  to  a  certain  degree,  the  powers 
of  both  remedies,  may  also  be  used  with  some  advantage  in  most  cases.  Coun- 
ter irritation  is  an  agent  of  great  influence  in  this  complaint,  and  may  be  estab- 
lished in  a  variety  of  ways,  which  it  is  unnecessary  to  enumerate;  but  a  very 
effectual  mode  is  by  making  a  small  blister  over  different  parts  in  succession, 
and  keeping  it  discharging  freely  for  several  days,  by  the  application  of  the 
French  dressing,  or  Albespeyer's  papers. 

After  the  removal  of  the  congestion  and  organic  changes  from  the  os  uteri, 
there  remains,  occasionally,  a  sensitiveness  of  the  part,  which  causes  the  patient 
much  discomfort,  and  which  will  be  best  relieved  by  the  use  of  the  bath,  as 
above  directed;  conjoined  with  anodyne  applications  to  the  part,  or  the  nitrate 
of  silver  in  solution;  the  best  mode  of  applying  which,  is  by  means  of  a  bent 
glass  tube  of  about  an  inch  in  diameter,  which  the  patient  can  introduce  and 
manage  for  herself;  all  that  is  necessary  is,  that  she  would  lie  on  her  back,  and 
introduce  the  tube  as  far  as  its  curvature,  and  then  pour  into  the  upper  end  the 
medicated  solution,  which  will  immediately  pass  to  the  os  uteri,  and  can  be 
retained  there  as  long  as  is  necessary,  the  tube  filling  the  vagina  sufficiently  to 
prevent  its  flowing  away,  which  Is  a  great  advantage. 

The  patient  should  be  strictly  enjoined  to  avoid  everything  that  could  stimu- 
late the  uterus — such  as  riding  on  horseback,  &c.;  but,  especially,  she  should 
refrain  from  indulgence  in  sexual  intercourse.  Wine,  if  used  at  all,  should  be 
of  a  very  mild  kind,  and  very  sparingly  taken;  and  the  same  rule  should  apply 
to  malt  drinks;  the  stronger  kinds  of  ale  and  porter  should  be  altogether  pro- 
hibited. 

No  circumstance  connected  with  the  treatment  of  this  affection  requires  more 
scrupulous  attention  than  the  regulation  of  the  patient's  habits  and  mode  of  liv- 
ing; indeed,  if  this  be  not  very  carefully  managed,  all  other  measures  will  most 
probably  be  defeated. 

In  illustration  of  the  foregoing  remarks.  Dr.  Montgomery  relates  several  cases 
which  terminated  successfully  under  the  treatment  laid  down  by  him.  Further 
researches,  however,  are  required  to  establish  that  the  nature  of  the  disease  is 
truly  cancerous. — Ibid.,  from  Dub.  Journ.  Med.  Sci. 

17.  (Edema  of  the  Glottis. — M.  Bricheteau,  in  a  memoir  in  the  .Archives  Gene- 
rales,  (Nov.  1841,)  endeavours  to  disprove  the  existence  of  this  affection  as  a  dis- 
tinct disease,  unconnected  with  other  affections  of  the  larynx.  M.  Bricheteau 
criticises  the  facts  adduced  in  Bayle's  paper  on  the  subject,  and  laments  their  in- 
completeness, as  well  as  that  of  the  cases  which  are  found  in  the  thesis  of  M. 
Thuillier.  M.  Bouillaud  published  three  observations  in  the  year  1825  tending  to 
prove  that  this  disease  is  in  reality  an  inflammation  of  the  larynx,  pharynx,  and 
surrounding  parts.  The  remarks  contained  in  the  prize  essay  of  MM.  Trousseau 
and  Belloc  favour  the  same  conclusion,  which  is  further  strengthened  by  the  three 
cases  detailed  by  the  present  author.     Two  of  these  cases  terminated  in  reco- 


1842.]  Medical  Pathology  and  Therapeutics,  173 

very,  but  in  the  third  the  patient  sank  after  the  performance  of  tracheotomy. 
Some  disease  of  the  larynx  existed  in  all  three  instances,  to  which  cedema  of 
the  glottis  succeeded. 

This  cedema,  which,  strictly  speaking,  affects  the  lips  of  the  glottis,  not  the 
glottis  itself,  is  always  a  very  serious  affection,  on  account  of  the  seat  which  it 
occupies.  It  cannot,  however,  be  regarded  as  an  idiopathic  disease,  and  is  itself 
more  frequently  an  inflammatory  affection  or  a  purulent  infiltration  into  the  part 
than  a  serous  effusion.  It  supervenes  in  the  course  of  various  diseases  of  the 
larynx,  and  should  not  occupy  a  different  place  in  works  on  pathology  from 
cedema  of  tumefaction  or  a  part  produced  by  any  morbid  poison,  or  from  the 
various  symptoms  which  attend  syphilis,  or  from  ulcerations  of  the  intestines  in 
fever.—i?.  ^  F.  Med.  Rev.  April,  1842. 

18.  Complete  obliteration  of  the  Aorta.  By  Prof.  Roemer,  of  Vienna. — An  offi- 
cer, high  in  rank  in  the  Austrian  army,  who  had  served  during  the  war  from 
1770  to  1815,  and  had  always  enjoyed  good  health  till  his  45th  year,  went  at 
that  time  to  reside  at  Mayence.  He  then  suffered  frequently  from  dyspnoea 
and  gastralgia,  but  did  not  apply  for  medical  advice  until  he  had  had  several 
attacks  of  threatened  suffocation,  and  his  stomach  had  refused  to  receive  every 
kind  of  food.  During  a  year  he  was  treated  homoeopathically,  without  benefit. 
Severe  palpitations  then  came  on,  accompanied  by  cedema  of  the  extremities. 
The  continued  use  of  bismuth  and  digitalis  made  the  dyspnoea  and  vomiting 
almost  entirely  disappear,  but  the  pulse  continued  rapid,  vibrating,  and  full. 
As  his  decease  approached,  he  was  seized  with  hoarseness,  and  a  small  dry 
cough;  and  at  last  he  expired  suddenly,  in  his  fiftieth  year,  while  playing  at 
whist. 

Post-mortem  examination. — The  contents  of  the  cranium  were  healthy,  with 
the  exception  of  a  softened  and  exsanguine  state  of  the  brain,  and  ossification  of 
the  basilar  artery.  Four  ounces  of  serum  were  found  at  the  base  of  the  skull. 
The  heart  was  considerably  hypertrophied;  the  valves  were  healthy.  The  aorta, 
as  far  as  the  origin  of  the  arteria  innominata,  was  much  dilated,  which  latter 
was  almost  twice  its  normal  size.  The  subclavians  and  the  left  carotid  artery 
did  not  appear  unnaturally  large.  The  coronary  arteries  were  ossified  to  the 
extent  of  about  three  inches.  From  the  origin  of  the  arteria  innominata,  to  the 
point  where  the  ductus  arteriosus  enters,  the  aorta  became  gradually  smaller, 
and  at  this  latter  spot  the  diameter  did  not  exceed  half  an  inch;  it  was  there 
found  obliterated  to  the  same  extent;  its  thoracic  and  abdominal  portion  was 
hardly  as  large  as  that  of  a  child  ten  or  twelve  years  old;  the  walls  of  these  ves- 
sels were  evidently  thickened.  The  intercostal  arteries,  which  arose  below  the 
obliteration,  had  nearly  the  diameter  of  a  quarter  of  an  inch,  and  communicated 
freely  between  the  third  and  fourth  ribs,  with  the  mammary  and  thoracic  arte- 
ries. It  was  by  means  of  these  anastomoses  that  the  collateral  circulation  was 
established;  the  pulmonary  arteries  were  greatly  dilated;  the  left  laryngeal  re- 
current nerve  was  greatly  stretched,  and  the  turn  which  it  makes  round  the  aorta 
corresponded  to  the  obliterated  point  of  that  vessel.  Biliary  calculi  were  found 
in  the  gall-bladder.  The  lungs  and  other  organs  were  healthy. — Lond»  and 
Edin.  Monthly  Journ.,  April,  1842,  from  Archives  Gen.,  Dec.  1841. 

19.  Typhoid  fever  in  the  Foetus. — Dr.  Manzini  has  written  to  the  Academy 
of  Sciences  of  France,  that  he  has  found  the  alterations  of  the  intestinal  follicles 
characteristic  of  typhoid  fever,  in  the  body  of  a  seven  months'  child,  who  died 
20  or  30  minutes  after  birth.  Many  physicians  witnessed  the  autopsy,  and  can 
testify,  he  adds,  to  the  truth  of  his  statement.— G«z.  Med.  de  Paris,  Dec.  4, 1841. 

20.  Tincture  of  Catechu  in  fissure  of  the  Nipple. — A  writer  in  the  Lancet,  30th 
April,  1842,  states  that  he  has  found  the  tincture  of  catechu  applied  twice  a  day 
with  a  camel's  hair  pencil,  very  efficacious  in  that  troublesome  affection,  fissure 
of  the  nipple.  In  one  case,  he  states,  the  nipple  which  had  been  intolerably  pain- 
ful for  weeks,  and  was  denuded,  returned  to  its  natural  state  within  a  day  or  two, 

15* 


174  Progress  of  the  Medical  Sciences.  [July 

and  the  mother,  who  was  about  to  wean  her  child  in  despair,  was  able  to  suckle 
it  for  more  than  twelve  months  without  any  inconvenience. 

21 .  Cases  of  unexpected  recovery  from  large  Mscesses  in  the  Lungs. — Dr.  Graves 
has  published  six  cases  of  abscesses  in  the  lungs,  which  occurred  in  his  own 
practice  and  that  of  his  friends,  in  which  complete  recovery  took  place.  The 
abscesses  were  situated  both  in  the  upper  and  lower  part  of  the  lungs,  and  were 
pneumonic,  as  proved  in  several  of  them  by  the  excessive  fetor  of  the  expecto- 
ration, although  the  history  of  the  case  in  some  would  have  led  (as,  in  fact,  it 
did,)  the  medical  attendant  to  suppose  that  they  were  cases  of  phthisis.  He  has 
given  them  to  the  public,  to  show  "that  patients  may  recover,  contrary  to  the 
usual  interpretation  of  the  most  significant  and  decisive  stethoscopic  symptoms, 
and  therefore  seem  to  merit  publication,  in  order  to  warn  practitioners  from  rely- 
ing too  exclusively  upon  physical  phenomena,  and  too  hastily  concluding  that 
pulmonary  lesions,  however  extensive,  thus  indicated,  must  necessarily  prove 
fatal."  They  show,  also,  "  that  real  circumscribed  abscess  occurs  more  fre- 
quently in  the  pulmonary  tissue  than  Laennec  allowed,  or  his  followers  seem 
to  believe."  The  two  following  cases  which  we  shall  give,  were  under  the  care 
of  Dr.  Stokes,  whose  name  is  a  sufficient  guarantee  for  the  accuracy  of  the  phy- 
sical signs  observed. 

Case  1.  Mr.  H.,  a  gentleman  aged  about  22,  was  attacked  with  pain  in  the 
side,  cough,  and  fever,  and  in  a  short  time  with  very  copious  purulent  expecto- 
ration. Soon  after  this,  the  signs  of  extensive  abscess  made  their  appearance 
in  the  antero-superior  and  lateral  posterior  regions  of  the  lung.  The  patient 
was  then  considered  to  labour  under  tubercular  caverns  to  a  great  extent. 
Shortly  after  Dr.  S.  saw  him,  he  presented  the  following  symptoms: — The 
whole  antero-superior,  lateral,  and  posterior  upper  part  of  the  left  lung,  sounded 
extremely  dull;  perfectly  distinct  cavernous  breathing,  with  large  gurgling  and 
pectoriloquy  were  heard  from  the  second  rib  down  to  the  mamma;  and  the  same 
phenomena  were  audible  along  the  fold  of  the  pectoral  muscle,  from  the 
axilla  to  the  seventh  rib.  The  expectoration  was  copious,  muco-puriform,  but 
not  fetid,  and  the  pulse  full,  regular,  and  under  90°.  The  treatment  adopted 
was  palliative.  The  pulse  soon  became  natural,  all  hectic  fever  ceased,  the 
dulness  of  sound  on  percussion  was  gradually  diminished,  and  the  patient,  in 
the  course  of  some  months,  was  perfectly  restored  to  health,  all  the  signs  of 
caverns  having  completely  disappeared. 

2.  Mr.  D.,  aged  about  25,  high  shouldered,  and  with  a  remarkable  stoop,  was 
attacked  with  cough  in  the  autumn  of  1839.  His  pulse  became  quick,  he  lost 
flesh  rapidly,  and  presented  the  usual  constitutional  symptoms  of  phthisis  in  an 
early  stage.  Within  a  few  weeks  of  the  invasion  of  the  disease,  Mr.  D.  began 
to  expectorate  from  half  an  ounce  to  an  ounce  daily  of  a  sanious  purulent  matter, 
having  the  colour  of  urine,  but  not  offensive.  He  soon  after  came  to  town.  The 
right  clavicle  was  dull  on  percussion,  and  the  vesicular  murmur  feeble  as  far  as 
the  third  rib.  Above  the  clavicle,  most  distinct  gargouillement  existed;  and  the 
same  could  be  heard  in  the  acromial  region,  particularly  when  he  coughed. 
Soon  after  this  the  pulse  became  quiet,  and  the  expectoration,  though  still  pos- 
sessing the  above  character,  diminished  in  quantity.  The  patient  went  to  the 
Cove  of  Cork,  where  he  remained  for  the  greater  part  of  the  winter  season.  He 
returned  in  spring,  having  become  very  fat,  and  without  the  slightest  symptom 
or  physical  sign  of  any  pulmonary  disease. 

Dr.  G.  could  have  added  several  other  instances,  besides  the  six  he  has  pub- 
lished, of  pulmonic  abscesses  which  have  been  cured;  but  he  thought  it  unne- 
cessary, as  those  he  has  given  were  amply  sufficient  to  show  that  they  are  nei- 
ther so  rare  nor  so  hopeless  as  they  are  generally  believed  to  be. — Edin,  and 
Lond.  Monthly  Journ,  Med.  Set.,  March,  1842,  from  Dublin  Journal  for  January, 
1842. 

22.  Sympathetic  Pruritus. — Mr.  Walter  C.  Dendy,  in  a  paper  read  before  the 
Medical  Society  of  London,  relates  the  following  interesting  example  of  Sym- 
pathetic Pruritus, 


1842.]  Medical  Pathology  and  Therapeutics,  17S 

I  was  requested  to  see  a  young  married  lady  in  consequence  of  a  severe  and 
most  distressing  cutaneous  disease,  which  was  not  only  the  source  of  constant 
disquiet  during  the  day,  but  which  deprived  her  of  sleep  during  the  whole  night. 
I  was  aware  that  about  the  sixth  or  seventh  month  of  her  late  pregnancy  (her 
infant  being  at  this  time  some  months-old),  a  most  distressing  cutaneous  irrita- 
tion had  then  supervened,  which  was  the  source  of  many  sleepless  nights,  and 
increased  until  it  w^as  apparently  the  cause  of,  and  terminated  in,  premature 
confinement.  From  this  she  had  rather  a  protracted  convalescence,  in  conse- 
quence of  free  hemorrhage  and  exhaustion.  In  December  last  the  pruritus  re- 
curred with  increased  severity,  and  after  two  or  three  weeks  I  visited  her  in  the 
country.  Her  suffering  was  at  this  time  most  acute,  although  to  a  certain  degree 
remittent,  and  it  was  excited  by  comparatively  trivial  causes.  There  was,  how- 
ever, somewhat  of  a  regularity  in  its  remissions,  being  the  most  severe  about 
eight  or  nine  o'clock  in  the  evening:  a  sudden  or  loud  noise  would  at  any  time 
produce  it,  when  it  seemed  to  resemble  neuralgic  pain,  flitting  from  one  part  to 
another,  or  traversing  the  skin  in  lines. 

On  examination,  the  skin  over  almost  the  whole  body  was  studded  with  small, 
dark,  bloody  crusts,  apparently  from  the  abrasion  of  papulae  or  vesicles.  This, 
hovsrever,  was  a  fallacy.  As  1  sat  by  the  side  of  this  lady  during  the  greater 
part  of  an  evening,  I  could  immediately  examine  the  seat  of  the  pruritus  or 
stinging,  which  was  often  instantaneous  from  a  state  of  repose.  1  could  not, 
however,  discover  on  that  portion  of  her  skin  (which  was  naturally  peculiarly 
fair)  the  slightest  morbid  mark,  papula,  exanthem,  vesicle,  or  weal.  The  nails 
were,  however,  instinctively  applied  to  the  part,  and  then  a  weal  was  observed, 
and  soon  after  a  bloody  poipt  from  the  abrasion  of  a  papilla. 

It  was  clear  that  this  was  a  morbid  exaltation  of  the  state  of  the  papillary 
nerves,  an  error  of  innervation,  as  some  would  term  it,  or  hyperasthenia  of  the 
skin  from  remote  sympathy;  but  the  primary  functional  derangement  was  not  so 
clear.  We  know  that  changes  in  the  spinal  cord  will  give  rise  to  hyperasthenia 
of  the  skin,  and  that  depraved  hepatic  and  renal  secretions  will  alSo  produce  a 
variety  of  cutaneous  derangements.  In  the  former  affection  of  this  lady  the 
condition  of  pregnancy  was  very  judiciously  judged  to  be  the  exciting  cause  by 
my  very  experienced  friend,  Mr.  Martin,  who  attended  her  in  her  precarious 
confinement,  as  that  gentleman  found  the  pruritus  gradually  subside  on  her  de- 
livery, the  lochia,  perhaps,  in  some  degree,  acting  as  a  derivative.  In  a  sub- 
sequent correspondence  we  agreed  that  a  secondary  affection  of  other  organs 
was  the  immediate  exciting  cause. 

In  November  last  and  early  in  December  the  lady  had  been  subject  to  ir- 
regular uterine  discharges,  yet  there  was  a  suspicion  of  early  pregnancy;  but 
she  now  asserted  that  she  was  much  smaller  in  the  abdomen,  and  therefore  if 
the  ovum  were  still  in  utero,  it  was  probable  that  it  was  checked  or  blighted. 
The  digestive  functions  were  much  deranged;  there  was  no  appetite;  dyspepsia 
followed  the  swallowing  of  food;  the  evacuations  were  unhealthy;  extreme 
languor  and  exhaustion  ensued,  and  universal  distress  and  prostration  were  ap- 
parent. On  testing  the  urine,  which  was  flaky,  with  litmus  paper,  it  was  in- 
stantly changed.  The  indications  were  to  amend  these  secretions,  especially 
that  of  the  kidneys,  leaving  the  uterine  or  remote  causes  to  time,  at  the  same 
time  soothing  the  immediate  paroxysms.  Extract  of  colocynth  and  blue  pill 
were  occasionally  given  in  small  doses.  Acetate  of  potass,  tincture  of  hop,  and 
syrup  of  marshmallow,were  taken  perseveringly  three  times  in  a  day;  of  Dover's 
powder  twelve  grains  each  night  at  bedtime.  The  tepid-bath  was*  occasionally 
used;  a  strong  decoction  of  poppies  extensively  employed  in  the  evening  on 
retiring  to  bed. 

In  a  fortnight,  during  which  period  the  plan  was  most  assiduously  adopted,  I 
found  this  lady  improved  in  every  respect;  the  appetite  was  restored;  the  urine 
and  other  secretions  nearly  healthy;  the  paroxysms  of  pruritus  far  less  frequent; 
a  great  portion  of  the  nights  passed  in  sleep;  the  strength  returning,  and  she  was 
evidently  gaining  flesh.     These  amendments  continued  without  relapse,  and  in 


176  Progress  of  the  Medical  Sciences,  [July 

about  three  or  four  weeks  a  letter  to  me  announced  the  lady's  convalescence,  and 
an  unequivocal  progress  in  her  pregnancy. — Lancet,  April  16,  1842. 

23.  Suffocating  Catarrh. — Mr.  Robinson  recommends  closure  of  the  patient's 
nostrils  with  the  thumb  and  fore-finger  during  expiration,  and  leaving  them  free 
during  inspiration,  when  a  paroxysm  of  suffocating  cough  is  present,  and  he 
says  that  in  a  very  short  time  the  patient  will  be  relieved.  He  adds  that  he 
has  adopted  this  plan  whenever  he  had  occasion  so  to  do,  and  always  with  suc- 
cess.— Land.  Med.   Gaz, 

24.  Cough  from  Spinal  Irritation. — A  lady  had  been  under  treatment  for  some 
time  for  violent  fits  of  short  convulsive  nervous  cough,  which  came  on  several 
times  during  the  day.  The  paroxysm  lasted,  at  each  attack,  eight  or  ten  mi- 
nutes— in  fact,  till  she  was  quite  exhausted.  She  seemed  otherwise  in  perfect 
health.  There  was  no  affection  of  the  chest  or  larynx.  She  was  about  eight- 
and-twenty,  married,  of  a  very  fine  personal  appearance.  I  begged  to  examine 
the  spine:  it  was  perfectly  regular  and  straight;  but  on  tapping  the  spinous  pro- 
cesses of  the  vertebras  hard  with  the  end  of  my  finger,  percussion  of  the  three 
middle  dorsal  spines  caused  her  to  shrink  with  a  sense  of  inward  soreness  and 
pain.  I  slightly  broke  the  skin  at  two  places,  half  an  inch  to  one  side  of  the 
spinous  processes  of  these  vertebras  (producing  superficial  sloughs,)  by  rubbing 
it  with  potassa  fusa.  In  five  days  there  was  evident  amendment.  Twice  in  the 
fortnight  the  caustic  was  reapplied.  The  local  soreness,  and  the  cough  in  little 
more  than  this  period  had  vanished.  The  surface  broken  at  each  point  was  an 
oval,  half  an  inch  by  a  quarter  of  an  inch. — London  Med.  Gaz.,  February  4,  1842. 

25.  Hiccup  from  Spinal  Irritation. — A  young  lady,  aged  19,  was  placed 
under  my  care  for  violent  fits  of  hiccup,  for  which  she  had  been  under  treatment 
ineffectually  for  two  or  three  months.  She  was  pale  and  delicate  in  appearance; 
but  the  want  of  colour  was  natural  to  her,  and  her  constitution  was  good,  and 
her  health  not  otherwise  disturbed;  she  was  only  thinner  than  usual,  and  weaker, 
and  worn  in  spirits,  from  the  frequent  recurrence  of  the  fits  of  hiccup,  which 
supervened  on  any  exertion  or  surprise,  on  the  most  trifling  physical  or  mental 
excitement.  I  examined  the  back,  which  was  perfectly  straight;  but  I  found 
that  from  about  the  fourth  to  the  last  dorsal  vertebra,  on  tapping  the  spinous 
processes  a  sense  of  inward  soreness  was  produced.  I  resorted  to  the  same  me- 
thod as  in  the  last  case,  and  in  three  months  the  patient  had  quite  recovered. 
The  hiccup  had  not  been  the  only  symptom:  if  the  paroxysm  was  violent,  it  was 
sure  to  be  accompanied  with  pain  of  the  right  side,  and  a  thrilling  sensation  in 
the  right  ulnar  nerve  at  the  elbow,  extending  to  the  wrist  and  little  finger.  Fre- 
quent rests  during  the  day  in  the  recumbent  posture,  I  found  an  important  ac- 
cessory part  of  the  treatment;  with,  towards  the  close,  exercise  to  an  extent 
short  of  fatigue,  and  tonic  medicine. 

Three  years  afterwards  (June,  1841,)  this  young  lady  came  again  under  my 
care,  for  a  return  of  the  same  complaint.  It  had  been  brought  on  by  fatigue  and 
anxiety:  her  father  had  died,  and,  in  a  few  months  afterwards,  her  mother.  The 
hiccup  was,  in  this  attack,  as  troublesome  as  before  in  the  former:  there  was  the 
same  pain  in  the  right  arm  and  right  side;  and  a  new  feature,  weakness  of  the 
right  knee;  and  occasionally  a  short  fit  of  coughing.  The  same  inward  soreness 
of  the  back  was  present.  She  recovered  again  under  similar  treatment;  after 
which  she  went  to  Brighton,  by  my  advice,  and  bathed  frequently:  she  there 
completely  regained  her  full  health  and  strength.  In  both  of  these  attacks,  the 
local  tenderness  was  throughout  exactly  commensurate  with  the  tendency  to 
hiccup,  and  lessened,  decreasing  in  extent  and  intensity,  as  the  hiccup  les- 
sened."— Ibid. 

26.  Jlsphyxia—the  relative  importance  of  warmth  and  cold  to  the  surface. — The 
use  of  the  warm-bath  in  all  cases  of  asphyxia,  seems  to  be  a  practice  so  gene- 
rally adopted  that  we  must  invite  especial  attention  to  the  following  remarks, 


1842.]  Medical  Pathology  and  Therapeutics.  177 

extracted  from  a  paper  by  Mr.  Snow,  in  the  London  Med.  Gazette,  (Nov.  5, 
1841.) 

"A  consideration  of  great  practical  importance  in  the  study  of  asphyxia  is, 
the  influence  of  the  temperature  of  the  medium  in  which  it  takes  place.  Dr. 
Edwards,  of  Paris,  by  a  most  extensive  and  beautiful  set  of  experiments,  has 
proved  that  throughout  the  animal  kingdom,  asphyxia  is  much  more  sudden  at 
a  high  than  at  a  low  or  moderate  temperature;  and  that  even  cold-blooded  ani- 
mals, which  will  linger  for  hours  deprived  of  oxygen  at  a  low  temperature,  will 
die  as  quickly  as  mammalia  or  birds  in  water  at  blood  heat:  even  fishes  will  die 
in  a  few  seconds,  or  at  most  two  minutes,  in  water  at  100°  Fahrenheit,  that  has 
been  deprived  of  its  air  by  boiling,  although  this  temperature  would  not  injure 
them  with  sufficient  air.  He  found  that  new-born  mammiferous  animals  die 
most  slowly  in  water  at  about  60  degrees,  which  is  ordinary  cold  water,  and 
that  they  die  much  more  quickly  as  the  water  approaches  blood  heat.  Dr.  Ed- 
wards advises  that  persons  in  the  state  of  suspended  animation  should,  amongst 
other  measures,  be  exposed  to  the  cool  air:  and  that  the  application  of  heat 
should  be  avoided,  unless  indeed  just  a  momentary  application,  to  endeavour  to 
arouse  sensibility.  The  Royal  Humane  Society,  however,  directs  the  applica- 
tion of  warmth  in  all  practicable  ways,  not  only  as  an  auxiliary  to  artificial 
respiration,  but  even  to  commence  with,  if  the  means  for  the  latter  are  not  in 
readiness;  and  most  authors,  I  believe,  coincide  with  the  views  of  the  Humane 
Society.  Dr.  Edwards  considers  it  is  by  its  effects  on  the  nervous  system,  and 
through  that  on  the  heart,  that  a  high  temperature  produces  its  effects.  I  think 
that,  although  the  nervous  system  may  be  affected,  and  is  probably  the  channel 
of  its  impression,  yet  that  the  deleterious  effects  of  an  elevated  temperature, 
when  respiration  is  stopped,  depend  on  its  stimulating  the  capillary  circulation 
of  the  system,  and  thus  promoting  the  de-oxygenation  of  the  blood,  that  change 
which  is  antagonistic  of  respiration,  which  rules  its  extent  under  all  circum- 
stances, and  which,  in  fact,  constitutes  the  necessity  for  having  a  respiration. 
But,  whatever  view  we  take  of  this  point,  the  fact  of  the  influence  of  tempera- 
ture on  asphyxia  proves  that  the  application  of  heat  ought  to  be  avoided  until 
respiration  is  thoroughly  established,  when  it  will,  no  doubt,  be  a  useful  auxili- 
ary to  restore  sensibility  and  renovate  the  patient. 

"The  number  of  children  that  die  of  asphyxia  at  the  time  of  birth  is  very 
considerable.  Writers  on  midwifery  have  stated  that  one-twentieth  of  the  chil- 
dren brought  forth  are  still-born,  and  of  these  a  large  proportion  are  asphyxi- 
ated, from  various  causes,  often  at  the  very  moment  of  birth.  The  first  measures 
that  are  generally  and  very  properly  adopted,  when  a  child  is  born  in  a  state  of 
suspended  animation,  are  to  admit  the  cool  air  to  its  skin,  to  dash  a  few  drops 
of  cold  water  on  it,  and  use  similar  means  to  arouse  sensibility,  more  especially 
that  of  the  nerves  of  respiration.  From  the  great  vascularity  and  sensibility  of 
the  skin,  and  the  thinness  of  the  cuticle  of  new-born  children,  great  benefit  may 
be  expected  from  the  access  of  air  to  the  surface  of  the  body.  Immersion  in 
-warm  water  is  sometimes  had  recourse  to,  and  I  have  seen  it  completely  suc- 
cessful in  two  or  three  instances,  after  the  means  just  enumerated  had  failed; 
but  this  is  a  dangerous  measure,  one  which,  if  it  do  not  succeed,  will  quickly 
extinguish  any  possibility  of  recovery  which  may  exist,  as  we  have  already 
seen.  The  great  object  in  this,  as  in  every  case  of  asphyxia,  is  to  establish 
respiration;  and  if  the  patient  cannot  be  roused  to  perform  natural  breathing, 
artificial  respiration  must  be  had  recourse  to  as  quickly  as  possible. 

'•Several  eminent  authors  on  midwifery  recommend  breathing  into  the  lungs 
of  the  child,  if  other  means  are  not  at  hand;  but  not  m-uch  good  can  be  expected 
from  a  measure  which  would  undoubtedly  suffocate  a  living  child,  and  where 
there  is  any  disposition  to  natural  breathing,  this  will  be  decidedly  injurious* 
Allen  and  Pepys  found  that  air  which  had  been  once  breathed,  contained  about 
8  per  cent,  of  carbonic  acid,  and  that  if  the  same  air  were  breathed  over  and 
over  again,  till  suffocation  was  felt,  it  would  contain  but  10  per  cent,  of  the 
same  gas." 


178  Progress  of  the  Medical  Sciences,  [J"ly 

27.  Extensive  Disease  of  the  Pancreas.  By  James  A.  Wilson,  M.  D. — A  gentle- 
man's servant,  aged  41,  of  intemperate  habits,  unhealthy  complexion,  and 
distressed  countenance,  complained  of  constant  pain  at  the  epigastrium,  some- 
times heightened  to  agony.  He  described  it  as  "  a  pulling  together  of  the  pit  of 
the  stomach;"  which  he  felt  most  when  recumbent,  and  after  food;  and  which 
was  often  accompanied  by  headache  and  giddiness.  His  pulse  was  regular,  its 
beats  95  in  the  minute.  In  a  month  from  this  patient's  admission  into  St. 
George's  Hospital,  and  after  an  unusually  long  intermission,  the  pain  suddenly 
and  violently  returned.     Shivering  succeeded;  maniacal  delirium,  and  death. 

After-death  appearances. — A  considerable  layer  of  fat  over  the  muscles  of  the 
abdomen.  Pericardium  unusually  adherent  to  the  heart,  which  was  otherwise 
healthy.  Lungs  healthy.  Brain  softer  than  usual,  and  more  vascular  in  its 
medullary  substance.  Some  serous  fluid  on  the  arachnoid;  very  little  in  the 
ventricles.     Stomach  healthy.     Spleen  in  a  very  soft  state.     Kidneys  healthy. 

The  President,  (Dr.  Williams)  said,  that  the  case  which  had  been  read  was 
extremely  rare  and  valuable:  the  symptoms  marking  it  had  been  pain,  vomiting, 
and  severe  headache,  which  were  exactly  those  which  he  had  observed  lately  in 
a  patient  who  died  from  fungus  haematodes  of  the  pancreas.  The  pain  and 
vomiting  were  easily  accounted  for;  and  the  headache  he  had  attributed  to  the 
great  emaciation  of  the  patient,  and  to  the  sympathy  existing  between  the 
stomach  and  the  brain.  Dr.  Wilson  had  attributed  to  the  pancreas  the  office  of 
merely  diluting  the  bile;  and,  perhaps,  this  might  be  the  fact,  but  it  was  not 
proved  by  the  present  case,  because,  although  some  calcareous  matter  was 
found  in  the  duct,  it  did  not  follow  that  the  secretions  of  the  pancreas  were  en- 
tirely suspended,  or  incapable  of  permeating  the  mass:  neither  did  it  appear  that 
the  patient  had  suffered  from  any  such  affections  of  the  bowels,  as  made  a  pro- 
minent feature  in  the  case.  The  concretions,  nevertheless,  found  in  this  case 
being  similar  to  those  found  in  the  salivary  ducts,  seemed  to  point  to  the  fact 
of  the  pancreas  and  salivary  glands  having  a  similar  office,  and  was  another  in- 
stance of  the  truth  of  the  physiological  opinions  at  present  entertained  respecting 
the  uses  of  that  viscus. 

Mr.  Ancell  thought  that  there  was  so  much  contradiction  in  the  physiological 
facts  advanced  with  reference  to  the  office  of  the  pancreas,  that  no  conclusion 
<eould  be  drawn  from  them.  Thus,  even  as  to  the  chemical  composition  of  the 
|)ancreatie  fluid,  the  German  physiologists  asserted  that  it  was  alkaline,  while 
the  French  contended  that  it  was  acid.  As  great  a  contrast  also  existed  as  to 
the  quantity  of  fluid  secreted  by  the  gland;  for  while  Magendie  had  stated  that 
it  secreted  only  one  drop  of  fluid  in  the  half  hour,  other  writers  had  said  that 
the  quantity  secreted  in  that  period  was  half  an  ounce.  The  pathology  of  the 
pancreas  threw  no  further  light  on  the  subject,  for  there  were  no  general  facts  to 
go  upon.  Thus,  as  a  symptom  of  disease  of  this  organ,  vomiting  was  mention- 
ed as  generally  present;  and  one  author  had  gone  so  far  as  to  say,  that  if  a 
patient  suffered  from  vomiting  and  emaciation,  without  any  other  symptoms 
being  present,  he  should  consider  that  the  pancreas  was  diseased.  But  how  did 
this  statement  hold  good  when  tested  by  facts'?  Why,  out  of  twenty-six  cases 
of  disease  of  the  pancreas  recorded  by  Dr.  Abercrombie,  there  was  no  one  urgent 
symptom  in  most  of  the  cases  to  warrant  the  diagnosis  that  the  pancreas  was 
diseased.  In  many  cases  vomiting  was  present;  in  others  there  was  only  pain; 
in  some  there  was  pain  and  vomiting  also.  Vomiting,  however,  might  be  a 
mere  accidental  symptom,  and  he  dependent  on  the  involvement  of  the  stomach 
in  the  disease.  He  thought,  indeed,  we  had  no  fact  which  would  lead  us  to 
determine  that  the  pancreatic  fluid  was  of  any  direct  service  in  the  process  of 
digestion.  He  had  no  doubt,  however,  the  organ  had  an  important  office  to  per- 
form, and  he  thought  its  function  had  a  direct  effect  on  the  blood  itself. 

Dr.  Henry  Lee  had  seen  a  case  in  which  the  chief  symptoms  were  pain  in  the 
epigastrium  and  back,  with  emaciation  and  occasional  vomiting:  the  patient  was 
a  long  time  ill,  and  at  last  died.  After  death  the  stomach  was  found  to  be  per- 
forated at  its  posterior  part  by  the  head  of  the  pancreas,  which  had  become  en- 
larged, and  produced  ulceration  by  pressure  on  the  stomach.     The  edges  of  the 


1842.]  Surgery.  179 

ulcer  were  red,  and  the  structure  of  the  pancreas  was  lobular. — Lancet,  January 
22,  1842. 

28.  Influence  of  venereal  excesses  in  the  production  of  Apoplexy. — Dr.  Muynch 
has  in  many  instances  traced  apoplectic  attacks  to  venereal  excesses.  He  sup- 
poses that  they  first  augment  the  irritability  of  the  brain,  but,  in  consequence 
of  their  continuance,  soon  induce  a  state  of  permanent  debility,  and  diminution 
of  the  tonic  and  cohesive  power  of  the  nervous  system;  and  that  the  weakness 
caused  by  these  seminal  losses  is  of  a  much  more  severe  nature,  and  more  per- 
manent, than  even  repeated  blood-lettings  carried  the  length  of  producing  cere- 
bral anasmia. 

The  signs  which  precede  the  apoplectic  attacks  are  in  general  loss  of  the 
intellectual  faculties  to  a  greater  or  lesser  extent,  loss  of  memory,  incompetence 
for  any  continued  mental  exertion,  in  addition  to  the  loss  of  the  general  health. 
Convulsive  movements  of  the  muscles  of  the  arms  and  face  are  often  remarked, 
and  a  state  of  mind  approaching  idiocy  or  insanity. 

When  the  apoplectic  seizure  is  traceable  to  this  cause,  bleeding  is  highly  in- 
jurious. The  remedies  recommended  are  quinine  and  other  tonics,  valerian, 
arnica,  carbonate  of  ammonia,  &c.  together  with  frictions  along  the  vertebral 
column  with  some  stimulant  liniment. — Ed.  Med.  and  Surg.  Journ.  October, 
1841,  from  Annales  de  la  Socieie  de  Med.  de  Gand.  January,  1841. 


SURGICAL  PATHOLOGY  AND  THERAPEUTICS  AND  OPERA- 
TIVE SURGERY. 

29.  Treatment  of  Strangulated  Hernia  by  Opium. — Attention  has  been  recently 
drawn  to  this  important  subject,  by  Dr.  D.  Bell  of  Carlysle,  Dr.  A.  W.  Davis 
of  Presteign,  and  Mr.  George  Cooper  of  Greenwich. 

Dr.  Bell  was  led  to  the  employment  of  morphia  in  cases  of  strangulated 
hernia,  from  having  observed  great  prostration  of  strength  and  total  relaxation  of 
the  system  to  ensue  where  considerable  doses  of  that  article  had  been  given,  and 
m  i\\Q  Lond.  and  Edin.  Monthly  Jour,  of  Med.  Sci.  for  Sept.  1841,  he  relates 
three  cases  of  strangulated  hernia,  in  which  he  had  resorted  to  the  measure  with 
entire  success. 

Dr.  Davis  communicated  to  the  Provincial  Medical  Association  at  their  York 
meeting,  a  case  of  strangulated  hernia,  in  which  after  the  failure  of  all  the 
usual  means,  a  teaspoonful  of  laudanum,  repeated  at  the  end  of  two  hours,  was 
given;  which  caused  almost  immediately  so  much  prostration  of  the  muscular 
system  that  the  hernia  was  easily  reduced.  The  patient  was  a  strong  muscular 
man,  a  farmer's  servant. 

Mr.  Cooper  relates,  in  the  London  Medical  Gazette  (18th  Feb.  1842),  the  two 
following  cases,  equally  successfully  treated  by  the  same  method. 

John  Brown,  aged  50,  with  a  large  inguinal  hernia,  was  seized  with  symp- 
toms of  strangulation,  on  the  16th  of  November.  Applied  to  Dr.  Mitchell  on 
the  18th,  at  whose  request  I  saw  him.  The  symptoms  were  most  urgent;  and 
having  failed  with  the  taxis,  we  proposed  an  operation,  which  he  refused  to  sub- 
mit to.  On  the  19th,  Mr.  Busk  saw  him,  and  recommended  me  to  try  large 
doses  of  opium,  as  Mr.  Bransby  Cooper  had  informed  him  of  a  surgeon  in  So- 
mersetshire, who,  for  the  last  eighteen  years,  had  so  treated  such  cases.  I  im- 
mediately gave  4  grs.  of  opium,  which  relieved  the  pain  and  sickness,  but  pro- 
duced no  change  in  the  tumour.  In  four  hours  I  repeated  the  opium,  and  five 
hours  after  gave  a  third  dose  of  4  grs.  20th. — Free  from  pain  and  sickness;  the 
hernia  in  same  state;  he  had  occasional  sickness,  and  a  few  doses  of  opium  at 
intervals  till  the  bowels  acted,  without  any  apparent  alteration  in  the  hernia, 
from  which  time  he  quickly  recovered,  and  the  hernia  returned  by  degrees. 

Mrs.  Woodhouse,  aged  70,  was  taken  with  symptoms  of  strangulated  hernia 
on  the  22d  of  January,  and  sent  to  me  on  the  25th,  She  had  a  femoral  hernia 
which  I  could  not  reduce;  she  is  sure  it  was  not  present  before  the  22d,  when 


180  Progress  of  the  Medical  Sciences.  [July 

she  had  a  violent  fit  of  coughing-.  I  gave  her  two  grs.  of  opium,  with  the 
effect  of  relieving  the  pain  and  sickness;  five  hours  after,  2  grs.  more  opium. 
The  following  morning  she  said  the  hernia  was  gone,  and  she  was  quite  well; 
there  was  no  return  of  bad  symptoms,  but  the  bowels  did  not  act  till  the  29th. 

30.  Iodine  Injections  in  the  treatment  of  Serous  Cysts. — M.  Velpeau  was  in- 
duced, by  the  success  which  attended  the  use  of  this  means  in  the  treatment  of 
hydrocele,  to  adopt  it  for  various  kinds  of  serous  cysts,  enlarged  bursas,  &c., 
about  the  knee,  in  the  axilla,  breast,  neck,  and  other  parts.  The  proceeding 
consists  in  puncturing  the  cyst  with  a  trocar  proportioned  to  its  size,  emptying 
it,  and  then  injecting  through  the  canula  a  mixture  of  one  part  of  tincture  of 
iodine  with  two  parts  of  water.  This  having  been  retained  for  a  few  seconds, 
should  then  be  nearly  all  drawn  off  again.  The  pain  produced  by  this  operation 
is  generally  inconsiderable,  and  ceases  after  a  about  a  quarter  of  an  hour;  a  day 
or  two  after  reaction  takes  place  the  cyst  inflames,  though  never  severely;  in 
two  or  three  days  more,  resolution  commences,  the  cyst  diminishes,  grows  pale, 
shrivels,  and  in  two,  four,  or  six  weeks  the  cure  is  perfected.  It  is  rarely  de- 
layed beyond  this  time,  but  it  may  be  accelerated  by  rubbing  the  skin  over  the 
cyst  with  mercurial  or  iodine  ointment  when  all  the  signs  of  acute  inflammation 
in  it  have  passed  away. — British  and  Foreign  Med.  Rev.,  April  1842,  from  Bull. 
Gen.  de  Therap.,  Nov.  1841. 

31.  Permanent  closure  of  the  jaws  cured  after  a  lapse  of  five  years  hy  division  of 
the  masseter  muscle. — Prof.  Fergusson  records  in  the  Frov.  Med.  and  Surg. 
Journ.,  (29ih  Jan.  1842,)  an  interesting  example  of  this.  The  subject  of  the  case 
was  a  healthy  man,  35  years  of  age,  who  was  unable  to  open  his  mouth  more 
than  a  quarter  of  an  inch  between  the  incisor  teeth  of  the  upper  and- lower  jaw; 
he  was  of  course  unable  to  masticate.  This  condition  of  things  seemed  to  have 
resulted  from  an  abscess  which  had  probably  formed  in  the  substance  of  the 
lower  end  of  the  masseter  muscle,  and  had  left  a  tumour  of  the  size  of  half  a 
walnut.  "The  masseter  muscle,  though  it  had  long  been  out  of  use,  seemed 
of  its  usual  development,  and  felt  hard,  as  if  in  a  state  of  temporary  action. 
The  other  parts  of  the  cheek  seemed  healthy,  and  the  mucous  membrane  within 
was  in  a  natural  condition.  The  masseter  of  the  opposite  side  felt  somewhat 
flaccid,  but  otherwise  in  a  healthy  state." 

After  trying  iodine  without  benefit,  Mr.  F.  determined  to  divide  transversely 
either  a  portion  of  the  masseter  muscle,  or  its  whole  breadth.  "  I  supposed  that 
my  wisest  plan  would  be  to  try  the  effect  of  a  partial  division  first,  and  I  accord- 
ingly, with  a  very  narrow  blade,  cut  through  about  half  an  inch  of  the  anterior 
margin  of  this  muscle.  The  point  of  the  knife  was  passed  from  the  mouth 
through  the  mucous  membrane  and  buccinator  muscle,  a  little  below  the  parotid 
duct,  and  having  been  pushed  between  the  skin  and  the  masseter,  the  fibres  of 
the  muscle  were  divided  by  carrying  the  edge  from  without  inwards.  Only  a 
drop  or  two  of  blood  followed  the  withdrawal  of  the  knife;  the  divided  fibres 
separated  freely,  and  a  very  perceptible  effect  on  the  width  of  the  mouth  fol- 
lowed. After  the  lapse  of  fourteen  days,  being  convinced  that  the  benefit  of  this 
partial  division  of  the  muscle  was  likely  to  be  permanent,  I  now  resolved  to  cut 
through  its  entire  breadth,  and  accordingly  I  did  so  by  a  proceeding  nearly  simi- 
lar to  that  already  described, — the  chief  difference  being  that  of  pushing  the 
point  of  the  knife  near  to  the  posterior  margin  of  the  ramus  of  the  jaw,  so  as  to 
enable  me  to  make  a  complete  division  of  the  muscle.  The  knife  was  blunt 
towards  the  heel,  such  as  1  use  in  dividing  tendons  and  muscles  in  other  parts 
of  the  body,  so  that  the  wound  in  the  lining  membrane  of  the  mouth  was  not 
larger  than  the  aperture  made  in  pushing  the  blade  onwards  to  the  part  to  be 
divided.  Having  cut  every  fibre  until  the  edge  of  the  blade  came  in  contact 
with  the  bone,  I  withdrew  the  instrument,  when  about  an  ounce  of  blood  flowed 
from  the  wound  in  the  mouth,  and  a  considerable  swelling  occurred  over  the 
divided  part  of  the  muscle.  The  blood  continued  to  trickle  from  the  little  orifice 
for  some  time,  and  always  came  more  freely  when  the  swelling  was  compressed. 


^1 


1842.]  Surgery.  181 

At  last  it  seemed  to  cease,  and  the  patient  left  the  house  after  having  shown  me 
that  he  could  open  his  mouth  to  a  greater  extent  than  at  any  ti  me  (as  he  said)  dur- 
ing the  last  five  years.  I  did  not  continue  the  movements  of  the  javi^  much  at 
this  time,  as  I  observed  that,  whenever  I  did  so,  the  swelling  in  the  cheek  in- 
creased, whilst  there  was  greater  difficulty  and  increased  pain  in  subsequent 
attempts  to  open  the  mouth. 

"  When  I  next  saw  him  he  informed  me  that,  on  his  way  home,  the  swelling 
in  the  situation  of  the  wound  increased  to  a  very  considerable  extent,  and  the 
tension  was  so  great  that  he  could  not  move  the  jaw  without  considerable  pain, 
when  suddenly  a  stream  of  blood  issued  from  the  orifice  in  the  mouth,  and  the 
tumour  in  the  cheek  rapidly  diminished.  Eight  days  after  the  operation,  there 
was  still  some  swelling  from  effused  blood;  in  eight  more  it  had  nearly  disap- 
peared, and  the  movements  of  the  jaw  could  be  made  with  less  restraint  and 
pain  than  formerly.  More  than  a  month  after  he  had  ceased  in  his  attendance, 
he  called  upon  me  to  show  that  he  could  open  his  mouth  nearly  as  freely,  and 
that  he  could  now  masticate  his  food  as  efficiently  as  he  had  ever  done  in  his 
lifetime;  all  remains  of  effused  blood  had  been  absorbed;  the  original  swelling 
at  the  lower  part  of  the  masseter  was  much  as  when  I  first  examined  it,  and 
though  he  seemed  delighted  with  the  great  improvement  which  had  been  effect- 
ed, there  was  still,  as  it  appeared  to  me,  such  a  degree  of  rigidity,  that  he  could 
not  gape  to  such  an  extent  as,  doubtless,  he  could  have  done  in  his  earlier  days. 
I  recommended  him  to  move  the  jaw  freely  and  frequently,  and,  having  since 
heard  nothing  more  of  the  case,  presume  that  the  improvement  has  been  perma- 
nent." 

[In  the  numbers  of  this  Journal  for  Nov.  1831,  p.  47  and  50,  May  1S40,  p.  88, 
and  Aug.  1840,  p.  510,  will  be  found  recorded,  accounts  of  similar  cases  suc- 
cessfully treated.] 

32.  Formation  of  an  Artificial  Jlnusfor  the  relief  of  Intestinal  Obstruction. — This 
operation,  originally  proposed  by  Littre  in  1720,  and  recently  performed  by  M. 
Amussat,  in  six  cases,  in  five  of  which  it  is  reported  to  have  been  successful, 
was  performed,  in  March  last,  by  Mr.  T.  P.  Teale,  surgeon  to  the  Leeds  Gene- 
ral Infirmary  The  subject  of  the  case  was  a  woman,  54  years  of  age,  labour- 
ing under  intestinal  obstruction  from  stricture  of  the  sigmoid  flexure  of  the  colon, 
and  an  aperture  was  made  in  the  descending  colon,  without  opening  the  perito- 
neum. The  patient  died  on  the  seventh  day.  The  obstruction  had  been  com- 
plete for  ten  days  before  the  operation,  and  Mr.  T.  thinks  that  had  this  been  had 
recourse  to  a  few  days  earlier,  the  result  would  have  been  different.  The  case 
is  related  in  fall  in  the  Frov.  Med.  and  Surg.  Journ.,  March  19,  1842, 

33.  Artificial  Anus  in  lumbar  region  in  an  infant. — M.  Amussat  has  performed 
this  operation  on  an  infant  affected  with  congenital  imperforation  of  the  rectum. 
M.  A.  had  tried  to  open  the  rectum  through  the  anus,  but  was  unable  to  find  the 
gut;  he  then  made  an  artificial  opening  in  the  left  lumbar  region,  and  the  infant, 
now  two  months  old,  is  well.— Gaz.  des  Hopitaux,  No.  37. 

34.  Rupture  of  the  Spine,  by  a  violent  muscular  effort.  By  M.  Lasalle. — A 
man,  thirty-six  years  old,  was  taken  to  the  Maison  Royale  de  Sante  at  Charenton, 
in  a  state  of  furious  mania,  and  it  was  found  necessary  to  confine  him  to  his 
chair  by  means  of  two  leather  straps,  which  went  from  the  upper  part  of  its 
back  and  fixed  his  shoulders,  and  two  others,  which  went  from  the  same  part  a 
little  lower  down,  and  were  fastened  to  his  arms.  After  making  various  efforts 
to  break  from  his  confinement  the  patient  rose  up  from  his  seat,  threw  his  head 
forcibly  backwards,  and  then  flung  it  with  great  violence  forwards.  After  this 
last  movement  the  head  remained  bent  on  the  neck,  and  the  neck  on  the  chest, 
and  his  limbs  were  completely  paralyzed.  The  author  saw  him  soon  afterwards, 
and  found  an  absolute  loss  of  power  in  all  the  muscles  below  the  neck,  except 
the  diaphragm,   and  those  of  the  arms,  which  were  but  partially  paralyzed. 

No.  VII.— July,  1842.  16 


182  Progress  of  the  Medical  Sciences,  [July 

There  was  neither  bruise,  nor  swelling,  nor  deformity  in  the  course  of  the  verte- 
bral column. 

About  thirty-six  hours  after  these  events,  which  were  witnessed  by  a  keeper 
and  a  fellow  patient,  the  man  died,  with  all  the  usual  signs  of  pressure  on  the 
cervical  portion  of  the  cord.  On  examination,  a  solution  of  continuity  was 
found  between  the  fifth  and  sixth  cervical  vertebrae;  the  posterior  cervical  liga- 
ment and  the  interspinales  muscles  were  ruptured,  and  no  bond  of  union  remain- 
ed between  the  spinous  processes,  whose  bases  were  separated  so  as  to  expose 
the  remains  of  the  ligamentum  subflavum  and  the  membranes  of  the  cord.  The 
articular  surfaces  of  the  superior  oblique  processes  of  the  sixth  vertebra  were 
also  exposed,  and  its  left  transverse  process  was  fractured.  The  inter-vertebral 
substance  was  torn;  a  part  remained  attached  to  the  fifth,  a  part  to  the  sixth 
vertebra;  but  there  was  no  fracture  of  the  bones,  nor  any  material  displacement 
of  them.  The  dura  mater  at  the  ^at  of  the  injury  was  tinged  with  blood,  and 
the  surrounding  cellular  tissue  was  infiltrated  with  it.  None  of  the  membranes 
were  torn,  but  in  the  interior  of  the  cord,  opposite  the  injury,  there  was  a  vast 
ecchymosis,  extending  downwards  to  the  second  dorsal  and  upwards  to  the  third 
cervical  vertebra. — B.  ^  F.  Med,  Rev,  April  1842,  from  Gaz,  Med,  November 
27,  1841. 

35.  Wound  through  the  Sternum  and  arch  of  the  Aorta. — By  Dr.  Caspar. 
The  peculiarity  of  this  unique  case  is,  that  the  wound  was  made  with  a  com- 
mon dinner-knife,  only  moderately  sharp  at  its  point  and  its  edge,  three  and  a 
half  inches  long,  and  three-fourths  of  an  inch  broad.  With  this  a  man  stabbed 
his  wife  up  to  the  hilt.  She  died  in  an  instant;  and  the  wound  was  found  to 
have  passed  right  through  the  upper  part  of  the  sternum  into  the  arch  of  the 
aorta  and  the  right  lung.  The  bone  was  cleanly  pierced,  without  any  fracture 
or  splintering. — Ibid,  from  Caspar'^s  Wochenscrift,  January  1,  1842. 

[The  editor  of  the  New  York  Medical  Gazette  states  that  an  analogous  case 
occurred  in  that  city.  The  wound  in  this  case  was  made  with  a  common  table- 
knife;  it  passed  through  the  sternum  without  any  fracture  or  splintering,  and  pene- 
trated the  right  auricle.     Death  was  nearly  instantaneous.^ 

36.  Treatment  of  Ulcers  between  the  Toes. — Dr.  Schlesier  says  that  an  in- 
variably successful  method  of  treating  this  affection,  whether  it  have  a  syphi- 
litic origin  or  not,  is  to  sprinkle  them  thickly  day  after  day  with  red  precipitate, 
and  then  to  cover  them  with  dry  charpie.  The  cure  is  generally  effected  in  a 
few  days. — Ibid,  from  Med.  Zeit,  November  24,  1841. 

37.  Successful  amputation  in  spreading;  Gangrene. — The  propriety  of  amputat- 
ing in  spreading  gangrene  being  yet  an  unsettled  question,  every  fact  calculated 
to  aid  in  its  solution  must  be  regarded  with  interest.  We  invite  attention,  there- 
fore, to  the  following  case  related  by  A.  T.  S.  Dodd,  Esq.,  surgeon  to  the  Chi- 
chester Infirmary,  related  in  the  Prov.  Med.  and  Surg.  Journ,  January  22,  1842. 

Charles  Shotter,  aged  33,  a  gentleman's  coachman,  had  always  been  very 
healthy  till  about  eighteen  months  since,  when  he  had  a  severe  attack  of  fever, 
since  which  he  has  never  been  hearty;  was  admitted  to  the  Chichester  Infirmary, 
March  14,  1833.  His  hand  had  been  caught  in  a  chaff-cutting  machine,  which 
sliced  it  through  obliquely,  a  little  below  the  back  of  the  wrist  joint,  but  not 
dividing  the  soft  parts  in  the  palm,  and  leaving  the  thumb  and  little  finger  entire, 
except  some  slight  laceration  of  the  skin;  the  carpal  bones,  and  metacarpal, 
were  cut  through  in  the  same  oblique  direction;  the  great  artery  of  the  thumb 
was  uninjured,  and  only  the  arteria  radialis  indicts  bled  at  all  profusely,  and  this 
was  accordingly  tied.  There  had  been  some  considerable  hemorrhage  before 
his  arrival  at  the  hospital,  but  not  so  much  after  he  was  admitted;  indeed,  as  all 
the  larger  digital  branches  from  the  palmar  arch  were  divided  by  the  accident, 
I  was  surprised  to  find  so  few  bleeding. 

As  this  was  a  simple  case  of  incised  wound  without  contusion,  and  as  the 


1842.]  Surgery.  183 

saving  of  a  thumb  and  little  finger  would  be  a  desirable  object  to  my  patient,  I 
determined  to  try  to  do  so  in  preference  to  amputating  the  hand,  and  I  therefore 
turned  back  the  integument  of  the  palm,  so  as  within  a  little  to  meet  those  of 
the  back  of  the  wrist,  and  kept  them  in  their  place  by  sutures  and  adhesive 
plaster. 

All  things  went  on  well  till  the  fourth  day,  when  violent  inflammation  took 
place  at  the  wrist  and  forearm,  which  obliged  me  to  take  off  the  strappings. 
The  report  on  the  22d  of  March  is — There  is  a  good  deal  of  suppuration  in  the 
hand,  and  of  inflammation  up  the  arm;  countenance  distressed;  pulse  quick, 
weak,  and  irritable;  stump  looks  pretty  well,  except  that  the  granulations  are 
flabby;  there  is  a  dark-coloured  spot  on  the  forepart  of  the  arm  above  the 
wrist. 

23d.  Had  a  comfortable  night;  pulse  100;  inflammation  of  the  arm  rather 
less;  suppuration  free;  countenance  anxious;  tongue  brown;  a  large  gangrenous 
vesicle  upon  the  discoloured  spot. 

In  this  stage  of  the  case  the  question  of  amputation  was  not  entertained,  be- 
cause, the  inflamed  state  of  the  forearm  would  not  permit  its  performance  to 
save  the  elbow,  and  I  was  unwilling  to  give  up  hopes  of  doing  this,  by  subduing 
the  inflammation  which  was  the  cause  of  the  incipient  gangrene.  On  the  next 
day,  however  (24th),  I  found  that  the  vesication  had  spread,  and  that  the  pecu- 
liar hard  swelling  accompanying  gangrenous  inflammation  occupied  the  whole 
forearm,  while  emphysematous  crepitus  could  be  felt,  even  to  about  a  third  of 
the  lower  part  of  the  upper  arm.  There  was  no  line  of  demarcation  in  the 
skin;  indeed  the  integuments  of  the  whole  limb  about  the  lower  third  of  the 
forearm  were  only  inflamed,  not  gangrenous,  though  from  the  hardness,  swell- 
ing, and  emphysema,  I  could  not  doubt  that  the  gangrene  had  spread  along  the 
cellular  texture.  The  patient  made  little  complaint;  pulse  93;  countenance 
much  distressed.  This  being  the  state  of  the  case,  there  was  an  immediate 
necessity  for  deciding  the  question,  whether  it  was  better  to  wait  any  longer  in 
the  hope  of  a  line  of  demarcation  taking  place,  or  remove  the  limb  at  once,  and 
trust  to  the  hope  of  thus  putting  a  stop  to  the  destructive  progress  that  was 
going  on  rapidly.  With  the  consent  of  my  colleagues  I  decided  upon  the  lat- 
ter plan,  and  removed  the  limb  at  the  middle  of  the  upper  arm  by  the  circular 
operation.  The  only  remark  that  I  would  make  on  the  circumstances  of  the 
operation  is,  that  in  dividing  the  muscles,  they  retracted  little  or  nothing,  either 
at  the  time  or  afterwards;  they  were  slightly  dark-coloured,  but  otherwise  all  the 
part  cut  through  had  a  perfectly  healthy  appearance.  Not  more  than  half  a 
pint  of  blood  was  lost  at  the  time  of  the  operation.  Three  hours  afterwards  the 
patient  was  quite  comfortable.  From  this  time  he  went  on  extremely  well,  with 
the  exception,  first,  that  on  the  28th  the  integuments  of  the  stump  underwent  a 
smart  attack  of  inflammation,  which  yielded  to  one  application  of  leeches;  and 
secondly,  that  for  about  three  days  after  this,  several  sloughs  of  cellular  texture 
passed  into  the  dressings,  leaving  a  large  cavity,  which,  however,  soon  filled 
with  granulations.  These  accidents  of  course  retarded  the  case,  blit  he  was 
discharged  well  on  the  26th  of  April. 

Mr.  Dodd  is  of  opinion  that  in  the  selection  of  the  place  for  amputating  we 
should  be  guided  by  the  emphysematous  feeling,  not  the  external  appearances, 
"  This  proceeding,"  Mr.  D.  remarks,  "  demands  an  apparently  great  sacrifice  of 
limb;  but  as  it  is  an  established  general  axiom  in  surgery  to  remove  all  the  dis- 
ease, it  is  evident  that  if  we  are  to  consider  the  emphysema  as  a  certain  indica- 
tion of  the  disease  in  question  in  the  cellular  tissue,  the  only  safe  plan  will  be 
to  remove  the  limb  beyond  the  emphysema.  I  cannot  help  thinking  that  the 
very  frequent  ill-success  which  made  such  men  as  Pott  and  Thompson  decide 
against  amputating  in  spreading  gangrene  may  possibly  have  arisen  from  taking 
the  external  appearances  as  the  guide,  instead  of  the  state  of  the  internal  parts, 
to  be  discovered  by  the  touch.  1  am  aware  that  in  a  case  of  Mr.  Lawrence's, 
he  divided  the  parts  about  the  shoulder-joint,  which  were  full  of  emphysema, 
and  the  patient  recovered:  but  this  only  shows  what  the  powers  of  nature  may 
occasionally  do— not  what  we  may  safely  expect  of  her;  and  if  we  have  the 


184  Progress  of  the  Medical  Sciences,  [July 

option  of  cutting  beyond  all  feeling  of  crepitus,  I  conceive  it  will  be  right  to  do 
so  for  the  sake  of  security,  though,  when  we  cannot  even  do  this,  Mr.  Law- 
rence's case  shows  us  that  we  need  not  despair,  with  a  good  constitution,  of 
saving  the  life.  The  sloughs  in  my  case  were,  I  believe,  the  results  of  the  attack 
of  secondary  inflammation  of  the  stump,  and  therefore  a  mark  only  of  the  very 
irritable  state  of  the  system,  not  at  all  otherwise  connected  with  the  previous 
state  of  the  limb." 

38.  Reunion  of  the  Fingers* — M.  della  Fanteria  attended  a  young  girl  who 
had  two  fingers  cut  off  by  accident  while  engaged  in  domestic  affairs.  He 
found  the  fingers  in  some  bran,  in  which  they  had  fallen;  but,  to  his  great  sur- 
prise, they  were  both  cut  into  two  pieces.  He,  nevertheless,  determined  to  re- 
unite them  to  the  hand,  which  he  effected  by  strapping  and  sutures.  At  the 
end  of  a  few  days  union  was  perfect,  and  the  poor  girl  thoroughly  recovered  the 
free  use  of  her  fingers,  the  articular  motions  continuing.^!])  This  case  is  verified 
by  the  celebrated  Vacca,  and  by  Professor  Centofanti. — Frov.  Med.  and  Surg. 
Journ.  May  14,  1842,  from  Annali  di  Univ.  di  Med. 

39.  Varicose  crural  vein. — An  interesting  case  is  recorded  by  Dr.  de  Castella, 
in  the  "  Gazette  Medicale^^''  of  a  lady's  coachman,  who  presented  the  symptoms 
of  strangulated  hernia,  under  which  he  sank.  He  had  previously  positively 
asserted  he  never  had  a  rupture,  in  which  statement  he  was  confirmed  by  the 
results  of  a  careful  examination  of  the  rings.  On  examining  the  body.  Dr.  de 
Castella  was  exceedingly  startled  on  perceiving  a  round,  pyriform  tumour, 
larger  inferiorly  than  superiorly,  occupying  in  the  left  groin  the  situation  of 
crural  hernia.  It  was  about  two  inches  long  and  one  high,  elastic,  and  of  a 
brownish  colour.  He  immediately  proceeded  to  operate  as  for  hernia,  and  the 
result  was,  that  he  discovered  the  tumour  to  be  a  varix  of  the  crural  vein,  which 
was  obliterated  under  Fallopius'  ligament.  There  were  several  smaller  va- 
rices in  the  internal  part  of  the  thigh  and  leg.  The  Doctor's  alarm  arose  from  his 
belief  that  he  had  mistaken  a  case  of  hernia.  The  cause  of  death  was  peritonitis, 
from  cancer  of  the  rectum.  The  varix  may  be  distinguished  from  crural  hernia 
by  its  shape,  which  is  pyriform,  or  pedicular  as  it  were,  by  its  fluctuation  and 
colour,  and  by  the  presence  of  other  varices  in  the  course  of  the  crural  vein. 
The  hernia  is  globular,  hard,  and  more  closely  applied  to  the  crural  arch.  Petit 
mentions  a  case  where  a  similar  varix  was  mistaken  for  a  hernia. — Ihid. 

40.  Semi-amputation  of  the  Uterus. — Dr.  Grembler,  of  Neider  Orschel,  was 
suddenly  summoned  one  morning  to  an  hysterical  female,  aged  53,  who  had 
long  been  subject  to  procidentia  uteri.  On  his  arrival,  he  found  her  icy  cold, 
and  exceedingly  pale.  He  ascertained  that  she  had  just  removed  with  a  knife 
that  portion  of  the  uterus  which  projected  beyond  the  vulva,  and  that  consider- 
able hemorrhage  had  followed.  He  arrested  the  bleeding  by  the  use  of  the 
plug  and  styptics,  and  of  appropriate  internal  treatment.  That  portion  removed 
comprised  nearly  half  the  organ,  including  the  os  tineas.  The  patient  soon  got 
well,  but  her  recovery  was  succeeded  by  hysteria  and  nymphomania. — Ibid,  from 
Med,  Zeitung. 

41.  Introduction  of  Jlir  into  the  Veins. — Dr.  Godemer,  Physician  to  the  hos- 
pital of  Ambrieres,  in  Mayenne,  has  published  in  the  Transactions  of  the  Medi- 
cal Society  of  Indre  and  Loire,  three  cases  of  tumour  in  the  neck,  during  the 
amputation  of  which,  a  peculiar  hissing  noise  was  heard,  followed  by  the  instan- 
taneous death  of  the  patient.  The  only  abnormal  appearance  presented  on  the 
examination  of  the  body,  was  the  distension  of  the  cavities  of  the  heart  by  a 
great  quantity  of  air.  In  removing  large  tumours  from  the  neck,  or  from  near 
the  heart,  we  should  avoid  everything  by  which  the  entry  of  air  into  the  veins 
can  happen.  Among  these  causes,  M.  Godemer  classes  the  movements  given 
to  the  tumour,  in  dividing  the  circumjacent  cellular  tissue,  with  the  view  of 
removing  the  diseased  growth  whole.     To  avoid  this  inconvenience,  under  these 


1842.]  Surgery,  185 

circumstances,  he  removes  the  tumour  piecemeal,  and  since  he  adopted  that 
plan,  he  says  he  has  not  lost  a  single  patient  by  this  unfortunate  occurrence. 
Six  cases  of  tumour  of  the  neck  were  operated  on  by  him  in  1839  and  1840,  and 
with  success.  The  patient  suffers  a  little  more  pain;  but  in  exchange,  there  is 
not  any  danger  of  the  passage  of  air  to  the  heart,  and  the  consequent  immediate 
death  of  the  patient. — Ibid. 

42.  Necrosis  of  the  Os  Calcis. — M.  Mallespine,  who  has  examined  a  great 
many  cases  of  necrosis  of  the  os  calcis  in  children,  states  that,  although  gene- 
rally dependent  on  a  constitutional  cause,  it  remains  a  long  while  without  affect- 
ing the  other  bones  of  the  tarsus,  and  that,  in  general,  the  only  operation  needed 
is  the  extraction  of  the  sequestrum,  instead  of  the  amputation  of  the  leg.  This 
latter  operation,  he  says,  is  more  frequently  practised  than  needs  be,  because 
the  tumefaction  of  the  cellular  tissue,  which  is  sometimes  enormous,  the  situa- 
tion of  fistulous  openings  at  a  distance  from  the  os  calcis,  and  the  lateral  mo- 
bility of  the  foot  (the  result  of  the  destruction  of  the  os  calcis,  whereby  the  heel 
has  lost  all  power  of  resistance),  induce  the  practitioner  to  consider  the  disease 
more  advanced  and  more  extensive  than  it  really  is.  He  observes,  further,  that 
the  absorption  of  the  sequestrum  takes  place  very  rapidly,  and  that  the  new  bone 
destined  to  supply  the  place  of  the  diseased  one,  is  deposited  in  the  first  in- 
stance on  a  level  with  the  insertion  of  the  tendo  Achillis,  and  at  the  point  cor- 
responding to  the  calcaneo-cuboid  and  astragalo-calcanoid  articulations.  The 
articular  cartilages  are  not  destroyed,  and  generally  continue  intact  a  long  while; 
the  ligamentous  apparatus  is  generally  found  friable,  softened,  and  thickened; 
occasionally,  appearances  have  presented,  as  if  nature  were  about  to  supply  the 
place  of  the  lost  ligaments  by  a  fresh  apparatus. — Ihid.  from  Revue  Medicale. 

43.  Hypertrophied  state  of  a  fold  of  the  Schneiderian  membrane  mistaken  for 
nasal  polypus. — A  young  woman  was  admitted  into  the  Hotel-Dieu,  of  Cler- 
mont, for  the  removal  of  a  nasal  polypus,  of  which  she  presented  all  the  symp- 
toms. A  whitish  round  body  filled  up  the  nares,  and  a  probe  passed  up  by  the 
side  was  stopped  in  its  progress  by  its  pedicle.  Attempts  were  made  to  re- 
move it  in  the  usual  way  by  the  forceps,  but  in  vain,  and  each  effort  was  fol- 
lowed by  severe  pain  in  the  head;  another  examination  was  accordingly  insti- 
tuted, when  it  was  discovered  that  the  supposed  polypus  was  no  other  than  an 
hypertrophied  state  of  that  fold  of  the  Schneiderian  membrane  which  covers  the 
free  edge  of  the  inferior  turbinated  bone.  It  was  removed  with  a  pair  of  curved 
scissors  without  the  loss  of  a  drop  of  blood.. — Ibid,  from  Juurn.  des  Connass. 
Med,  Chirurg. 

44.  Van  Gesscker'^s  Bougies. — These  consist  of  a  strip  of  parchment  rolled  up  so 
tightly  that  its  layers  adhere  pretty  firmly  to  one  another,  and  they  have  at  one 
end  of  it  a  knob  or  drop  of  glue,  made  of  boiled  parchment.  This  knob  con- 
tributes very  much  to  the  facility  of  introducing  the  instrument  into  a  stricture; 
one  can  feel  it  slipping  in,  and  then,  by  the  heat  of  the  urethra,  it  melts,  and 
the  bougie  unrolls  of  itself,  while  the  melted  glue  is  retained  without  injury  to 
the  urethra,  and  does  not  possess  the  slightest  degree  of  any  irritating  quality. 
Such  instruments  may  be  manufactured  of  very  small  size,  and  yet  possess  suf- 
ficient strength;  and  their  unrolling  is  rather  advantageous  than  injurious,  in 
cansequence  of  the  slow  dilatation  to  which  the  stricture  is  thus  subjected. — 
B.  and  F.  Med.  Rev.  April  1842,  from  Arntzenius  on  organic  diseases  of  the 
urethra. 

45.  Ventral  Hernia. — A  beggar,  42  years  old,  who  had  led  a  hard  life  from 
infancy,  had  a  large  abscess  form  at  the  umbilicus,  which  burst,  gave  vent  to  a 
great  quantity  of  pus,  and  to  a  portion  of  epiploon,  which,  however,  readily  re- 
turned on  his  assuming  the  horizontal  position.  The  wound  cicatrised,  but  a 
hernia  followed,  and,  as  the  man  did  not  wear  a  truss,  it  increased  in  size,  and 
the  hernial  opening  was  so  large  that  the  hand  could  be  introduced  into  the  ab- 

16* 


¥ 


186  Progress  of  the  Medical  Sciences,  U^^Y 

domen.  Some  time  afterwards  a  similar  abscess  formed  on  the  external  edge 
of  the  right  rectus  abdominis,  followed  by  a  hernia;  and  this  again,  in  like 
manner,  by  an  abscess  and  intestinal  rupture  on  the  left  side.  A  year  after- 
wards a  fourth  abscess  formed  below  the  umbilicus,  which  was  succeeded  by  a 
hernia  of  the  omentum,  which  adhered  to  the  vicinal  parts,  and  did  not  protrude. 
All  this  took  place  without  the  man  leaving  work  or  seeking  medical  assistance. 
One  day  in  July  last  year,  after  a  full  repast,  while  ascending  a  staircase,  he 
was  seized  with  fainting  and  vomiting.  On  examination,  it  was  found  that  the 
left  ventral  hernia  had  burst,  and  a  portion  of  the  ilium  was  protruded.  M. 
Pellizo,  who  was  sent  for,  succeeded  in  replacing  the  protruded  gut,  and  cica- 
trisation took  place  without  the  occurrence  of  a  single  bad  symptom. — Prov. 
Med.  and  Surg.  Journ.  May  7,  1842,  from  Annali  Universali  di  Med. 

46.  Amputation  for  diseased  hone  in  Children, — M.  Tavignot  states,  as  the  re- 
sults of  his  experience,  that  amputations  ought  not  to  be  performed  on  children, 
as  long  as  there  is  hope  of  preserving  a  limb,  which  may  yet  be  of  some  ser- 
vice, unless  the  powers  of  life  are  endangered  by  colliquative  diarrhoea.  If  the 
disease  be  more  dangerous  than  the  operation,  then  the  latter  should  be  had  re- 
course to,  and  not  otherwise.  M.  Tavignot  denies  the  necessity  of  amputating, 
when  the  disease  in  the  bone  is  entirely  circumscribed,  even  if  there  be  sequestra 
and  fistulous  canals,  because  either  the  original  cause  of  the  disease,  the  stru- 
mous cachexia,  may  disappear,  and  the  disease  with  it,  or,  if  it  continue,  an 
affection  similar  to  that  for  which  the  operation  was  performed  will  be  developed 
elsewhere. — Ibid,  from  La  Clinique  des  Hopitaux  des  Enfans, 

47.  Spontaneous  Priapism  during  thirty  hours^  with  retention  of  Urine.  By  M. 
Demeaux. — A  young  man,  twenty-two  years  of  age,  of  a  good  constitution,  and 
of  a  fair  complexion,  with  a  largely  developed  genital  system,  came  to  Paris  in 
the  month  of  September.  He  had  been  in  the  habit  of  indulging  in  sexual  in- 
tercourse with  moderation.  On  the  night  of  the  10th,  after  no  irregularity  of 
diet,  and  after  coitus,  which  was  attended  by  an  extraordinary  degree  of  volup- 
tuousness, had  been  performed,  the  erection  of  the  penis  still  continued,  accom- 
panied with  a  burning  sensation  in  the  perineum,  and  along  the  course  of  the 
urethra.  From  time  to  time  exacerbations  took  place,  followed  by  a  general 
spasm,  during  which  there  was  a  kind  of  emission.  When  M.  Demeaux  saw 
him  at  three  in  the  morning,  he  found  him  much  debilitated,  with  an  anxious 
countenance,  burning  skin,  bathed  in  perspiration,  and  a  pulse  110,  full  and 
hard.  The  spasms  and  the  emission  still  continued.  The  penis,  much 
distended,  and  in  contact  with  the  belly,  felt  as  hard  as  a  piece  of  wood. 
The  glans  was  of  a  purple  colour,  and  the  testicles,  drawn  towards  the 
abdominal  rings,  were  painful  to  the  touch.  The  bulb  was  swollen,  and 
formed  a  hard  tumour  about  the  size  of  a  hen's  egg;  there  were  urgent  but 
ineffectual  efforts  to  pass  urine.  He  was  ordered  to  lie  on  a  hair  mattrass;  to  be 
bled  to  four  palettes;  to  have  a  cold  hip-bath;  an  enema  with  two  grammes  of 
camphor,  and  to  keep  a  bladder  of  ice  between  his  thighs.  Five  in  the  after- 
noon. The  emissions  had  ceased  since  taking  the  cold  bath,  but  the  local  symp- 
toms still  the  same;  to  have  a  draught  with  fifty  centigrammes  of  camphor;  fif- 
teen leeches  to  be  applied  to  the  perineum.  Eleven  in  the  evening.  The  spasms 
and  emissions  have  returned;  the  bladder  can  be  felt,  forming  a  round  tumour  in 
the  hypogastrium,  and  exceedingly  painful  on  pressure.  Leeches  to  be  applied 
to  the  perineum,  in  such  a  manner  as  to  keep  up  a  continued  loss  of  blood.  At 
two  in  the  morning,  after  sixty  leeches  had  been  applied,  the  penis  became 
somewhat  smaller.  He  was  then  placed  in  a  hip-bath,  at  the  temperature  of  the 
surrounding  air,  when  he  experienced  indescribable  relief.  In  about  ten  minutes 
he  was  able  to  make  urine;  he  was  taken  from  the  bath,  and  immediately  fell 
asleep.  From  this  time  all  went  on  well,  although  the  catheter  had  to  be  used 
several  times.  At  the  end  of  four  days  he  was  able  to  leave  Paris,  but  his  left 
testicle  was  still  painful  on  pressure. — Monthly  Journ.  Med.  Sci.^  May,  1842, 
from  Gaz.  Med.  de  Paris,  February  4,  1842. 


1842.]  Surgery.  187 

48.  Berarcfs  mode  of  applying  the  Vienna  caustic  for  the  cure  of  varicose  veins, 
— M.  Berard  maintains  that  tlie  peculiar  mode  in  which  he  applies  the  caustic 
is  of  great  importance  in  leading  to  success. 

In  the  first  place,  the  point  he  selects  for  applying  the  caustic  is  below  the 
knee,  over  the  course  of  the  vena  saphena  interna.  This  will  generally  be  found 
sufficient  to  remove  any  varicose  veins  that  may  exist  in  the  thigh;  and  even 
though  ihey  should  not  be  removed,  experience  proves  that  they  will  cause  no 
further  inconvenience  if  the  operation  succeeds  in  respect  to  the  leg;  while  any 
dangerous  accidents  after  the  application  are  much  more  likely  to  occur  when  it 
is  used  above  the  knee  than  below  it.  The  obliteration  of  the  vein  at  this  point 
is  usually  sufficient  to  cause  the  disappearance  of  the  other  varices  in  the  leg, 
though  it  may  sometimes  prove  necessary  afterwards  to  apply  the  caustic  to  one 
or  two  other  veins,  should  they  continue  enlarged.  In  the  next  place,  instead 
of  making  several  successive  applications  of  the  caustic  upon  the  same  point,  he 
applies  it  in  sufficient  quantity,  or  for  a  sufficient  space  of  time,  to  burn  at  once 
down  to  the  coats  of  the  vessel.  This  will  be  effected  by  allowing  a  thin  layer 
of  the  substance,  brought  to  the  consistence  of  a  paste  by  the  acid  of  alcohol,  to 
remain  on  from  a  quarter  of  an  hour  to  half  an  hour.  Lastly,  he  produces  a 
long  cicatrix,  instead  of  a  circular  one,  by  applying  the  paste  for  some  way 
downwards  along  the  course  of  the  vessel.  M.  Berard  states  the  advantages  of 
the  application  used  in  the  manner  here  prescribed  to  be,  that  it  requires  little 
or  no  suspension  of  the  patient's  ordinary  occupations,  that  in  general,  one  sin- 
gle operation  will  prove  sufficient,  that  it  is  seidomer  liable  to  be  followed  by 
serious  accidents  than  the  modes  commonly  in  use,  and  that  it  hardly  ever  fails 
in  effecting  a  permanent  cure. — Ibid. 

49.  Fracture  of  the  neck  of  the  Femur. — Mr.  B.  Cooper,  in  his  recent  course 
of  lectures  at  the  Royal  College  of  Surgeons,  attempted  to  show  that  fracture 
of  the  neck  of  the  femur  within  the  capsule  never  could  occur;  that,  in  fact, 
nature  never  intended  that  it  should.  He  entered  at  considerable  length  into  the 
arguments  which  had  been  adduced  on  both  sides  of  this  contested  point,  and 
denied  that  a  case  of  osseous  union  of  the  neck  of  the  thigh  bone  within  the 
capsule,  had  ever  occurred. — Lancet,  March  19,  1842. 

50.  Dislocation  of  the  Sternum. — M.  Maissoneuve  presented  to  the  Academy 
of  Medicine  of  Paris,  at  their  meeting  of  the  28th  of  March  last,  two  prepara- 
tions taken  from  patients  who  had  luxation  of  the  first  portion  of  the  sternum 
on  the  second — a  very  rare  accident. 

The  first  preparation  was  from  a  man  aetat.  32,  who  fell  from  a  height  of  40 
feet  on  his  neck.     He  survived  six  weeks. 

The  second  was  from  a  man  setat,  42,  who  fell  from  a  height  on  his  pelvis  and 
was  instantly  killed.  The  lesion  of  the  sternum  was  the  same  in  both  cases: 
the  second  portion  was  forced  anterior  of  the  upper,  the  periosteum  in  front  was 
not  lacerated. 

51 .  Wounds  of  the  Femoral  vein  in  operations  fur  Aneurism.  By  Mr.  Hadwen. 
— This  is  one  of  the  most  melancholy  accidents  which  can  happen,  in  the  ope- 
rations on  this  artery;  and  it  may  occur  in  the  hands  of  the  most  skilful  opera- 
tor, as  well  as  in  those  of  the  unskilful.  There  is  scarcely  an  instance  on  record 
of  the  patient's  recovery  incases  where  the  vein  has  been  wounded.  Mr.  H. 
thinks  that  the  fatal  results  are  not  owing  to  the  wound  of  the  vein,  but  to  the 
ligature  which  is  applied  to  the  artery,  including  a  part  of  the  vein.  He  has 
seen  the  internal  jugular  wounded  in  an  operation  on  the  neck,  where,  although, 
the  hemorrhage  was  great,  yet  it  ceased  immediately  when  the  operation  was 
finished,  and  the  parts  had  regained  their  natural  relations.  He  takes  for  grant- 
ed that  simple  wounds  of  veins,  as  a  general  rule,  both  superficial  and  deep, 
properly  treated,  are  unattended  by  danger.  It  is  quite  unjustifiable,  he  thinks, 
to  lie  the  artery  at  the  place  where  the  vein  has  been  injured;  and  the  practice 
that  he  would  adopt  in  such  a  case  is,  to  open  the  sheath  of  the  vessels  an  inch 


188  Progress  of  the  Medical  Sciences,  [}^^V 

above  the  injury  of  the  vein,  and  tie  the  artery  there,  provided  there  should  ap- 
pear sufficient  room  between  the  wound  and  the  deep  artery  of  the  thigh,  to  jus- 
tify its  application;  if  not,  to  go  the  same  distance,  or  more,  below.  If  the 
aneurism  is  in  a  state  which  admits  ©f  the  necessary  delay,  it  becomes  an  in- 
quiry, whether  it  might  not  be  better  practice  to  allow  the  wound  entirely  to  heal 
before  the  artery  is  exposed  a  second  time.  The  only  recommendation  this 
course  appears  to  present  is,  the  entire  cessation  of  inflammatory  action  it  would 
admit  of  in  the  vein,  before  the  possibility  of  fresh  disturbance  could  arise  from 
the  ligature.  On  the  other  hand,  we  must  bear  in  mind  the  effect  of  a  failure 
and  second  operation  on  the  patient.  These  are  circumstances,  however,  which 
each  individual  case  and  operation  must  determine.  Future  experience,  he  says, 
may  decide  whether  the  safest  plan  would  be  to  pursue  the  treatment  about  to 
be  mentioned;  but  at  present,  he  is  not  prepared  to  give  it  unqualified  recom- 
mendation. In  a  case  of  operation  on  this  artery,  at  which  he  was  present,  and 
where  the  femoral  vein  was  wounded,  he  urged  that  the  ligature  on  the  artery 
should  only  be  allowed  to  remain  a  sufficient  time  to  give  the  artery  a  fair  chance 
of  being  obliterated,  and  then  to  remove  it.  His  advice  was  adopted;  and  in  a 
fortnight  the  wound  was  quite  healed,  and  the  patient  in  perfect  health.  It 
would  be  difficult,  he  says,  perhaps  impossible,  to  collect  from  a  single  instance, 
stronger  support  for  the  position  he  has  assumed,  than  this  case. — L.  ^  E, 
Monthly  Journ.  of  Med,  Sci.  from  Lond,  Med.  Gaz.,  April  9,  1841. 

52,  Polypi  of  the  Rectum  in  Children. — Prof.  Stolz  has  published  in  the 
Gazette  Medicate  of  Strasbourg,  a  pamphlet  on  polypi  of  the  rectum  in  children. 
This  disease,  he  says,  occurs  from  lime  to  time,  and  has  almost  never  been 
taken  notice  of  by  any  of  those  authors  who  have  written  on  diseases  of  chil- 
dren, having  been  taken  for  a  prolapsus  of  the  gut.  The  case  which  first  occur- 
red to  him  was  in  a  boy  five  years  old,  and  presented  the  following  symptoms: — 
For  eighteen  months  he  had  had  frequent  desire  to  go  to  stool;  and  for  a  year, 
at  each  time  that  he  went,  he  had  passed  a  red  and  bloody  tumour,  which  is  about 
five  or  ten  minutes  returned  of  itself.  His  parents,  and  several  medical  men 
who  were  consulted,  believed  that  he  laboured  under  a  prolapsus  of  the  rectum. 
Professor  Stolz  at  first  was  of  the  same  opinion,  and  various  injections  were  ac- 
cordingly ordered.  After  several  weeks,  upon  examining  him  minutely,  he  dis- 
covered, that  it  was  not  a  prolapsus,  but  a  tumour  of  the  size  of  a  small  nut, 
and  covered  with  a  bloody  mucus,  which  was  protruded.  It  was  attached  not 
very  high  up  the  gut,  by  a  pedicle  of  about  the  thickness  of  two  millimetres,  to 
the  mucous  membranes  of  the  rectum.  A  ligature  of  silk  was  accordingly  put 
round  it  and  tied.  In  three  days  it  came  away;  no  bad  symptoms  followed,  and 
the  child,  who  had  been  in  bad  health  previously,  from  loss  of  blood,  soon  re- 
covered his  strength.  Two  other  cases  have  occurred  to  the  Professor  since; 
and  he  has  heard  from  his  colleagues  of  several  more.  In  one  of  the  cases 
which  he  had,  he  removed  the  tumour  by  means  of  scissors.  No  blood  follow- 
ed at  the  time;  but  in  about  two  hours  after  there  was  copious  hemorrhage, 
which  put  his  patient's  life  in  danger.  The  bleeding  was  arrested  by  compresses 
dipped  in  cold  water,  and  by  cold  injections.  The  child  soon  made  a  good 
recovery,  and  soon  regained  his  strength. 

This  last  case  is  another  example  of  the  danger  of  making  any  incision  in  the 
rectum,  or  even  in  its  neighbourhood,  without  carefully  plugging  the  wound 
afterwards. — L.  ^  E.  Monthly  Journ.  Med.  Sci.  February,  1842. 

53.  Cases  of  double  Hare-lip— period  of  life  most  suitable  for  operating  for  this 
deformity. — Mr.  Houston  communicated  to  the  Surgical  Society  of  Ireland  two 
cases  of  hare-lip  operated  on  by  him  at  an  early  age,  and  made  some  interesting 
observations  on  the  most  suitable  time  of  life  for  operation. 

Case  I.  Mary  Fox,  two  years  and  a  half  old,  the  fourth  child  of  a  robust 
healthy  mother,  was  admitted  into  the  City  of  Dublin  Hospital,  June,  1841,  for 
double  hare-lip,  and  double  fissure  of  the  palate.  The  first  child  of  this  woman 
had  been  born  with  the  same  deformity;  the  second  and  third  were  well  formed 


1842.]  Surgery.  189 

at  birth.  The  central  piece  of  lip  was  large,  a  little  inclined  to  the  left  side,  and 
nearly  the  whole  depth  of  the  lip.  The  sides  of  the  lateral  fissures  were  con- 
tinued, inferiorly,  nearly  into  each  corner  of  the  mouth,  leaving  very  little  infe- 
rior red  border;  superiorly,  that  of  the  right  side  was  continuous  in  the  nose 
with  the  fissure  in  the  palate:  that  of  the  left  did  not  enter  into  the  nostril,  al- 
though it  approached  within  a  line  of  it.  The  central  piece  of  bone  under  the 
nose  was  very  prominent,  and  contained  two  deformed  incisors,  one  of  which 
projected  forwards,  the  other  to  the  right  side  over  the  fissure  between  the  bones. 
The  nose  was  broad  and  flat;  and  the  whole  exhibited,  especially  when  the 
child  laughed  or  cried,  a  great  and  ugly  gap — deformities  which  were  observed 
by  the  mother  to  be  growing  more  hideous  every  day.  The  infant  had  never 
been  able  to  suck;  and  the  act  of  swallowing  had  been  always  slow  and  im- 
perfect. It  was,  nevertheless,  healthy  and  fat,  and  in  every  other  respect  well 
shaped.  Mr.  Houston  then  went  on  to  say  that,  on  the  7th  of  June,  the  opera- 
tion was  proceeded  with,  in  the  presence  of  his  coleagues.  Professors  Benson, 
Hargrave,  and  Williams,  and  Mr.  Orr;  the  child  being  rolled  up  in  a  sheet  to 
keep  its  arms  and  legs  quiet,  and  placed  sitting  on  the  knee  of  an  assistant. 
The  lips  of  the  fissure  were  first  freely  detached  from  the  bones  by  an  incision, 
with  a  scalpel,  through  the  mucous  membrane.  The  outer  lamina  of  the  pro- 
jecting bone,  together  with  the  protruding  teeth,  was  then  sliced  off  with  nip- 
pers, so  as  to  be  rendered  quite  flat,  and  to  afford  a  level  support  to  the  lip 
afterwards,  but  was  not  cut  through  in  any  part.  Scissors  were  used  to  the  lips, 
the  angles  being  held  by  a  tenaculum.  The  sides  of  the  central  piece  were 
trimmed  first,  so  as  to  leave  it  nearly  the  full  breadth,  and  about  two  lines  deep. 
The  lateral  borders  were  then  excised,  care  being  taken  to  cut  well  to  the  cor- 
ners of  the  mouth,  so  as  thereby  to  remove  completely  the  rounded  angles, 
which  are  always  present  in  such  cases,  at  the  junction  between  the  vertical  fis- 
sure and  the  natural,  free  red  border.  The  needles  used  by  Mr.  Houston  were 
two  long,  fine,  wollen  or  darning  needles,  on  which  triangular  points  had  been 
ground  for  the  occasion.  The  lower,  which  was  introduced  first,  brought  the 
lateral  pieces  together  with  every  exactitude,  close  above  the  free  border;  the 
upper  one  took  in  the  central  piece  in  its  passage  across  from  the  one  side  to  the 
other,  and  by  its  proximity  to  the  nose,  closed  at  the  same  time,  completely,  the 
fissure  into  the  right  nostril.  The  needles  entered  with  much  readiness,  and,  as 
one  advantage  resulting  from  their  length,  it  was  found  unnecessary  to  pass  a 
ligature  on  either  until  the  fitting  place  and  direction  for  both  had  been  fully  ap- 
proved of.  The  cheeks  being  now  well  pushed  forward  by  an  assistant,  the  in- 
cised surfaces,  including  those  of  the  central  piece,  fell  accurately  together,  and 
a  very  moderate  pressure  with  a  ligature,  applied  in  the  figure  of  8  shape,  was 
found  effectual  in  keeping  them  so. 

The  projecting  ends  of  the  needles  were  then  nipped  off,  and  their  stumps 
covered  with  little  rolls  of  adhesive  plaster.  The  application  of  strips  of 
plaster  to  support  the  cheek,  and  take  off  all  drag  from  the  needles,  completed 
the  operation.  After  the  operation,  the  child  fell  asleep.  During  the  succeed- 
ing days,  there  was  slight  feverishness,  indicated  by  hot  skin,  restlessness,  and 
loss  of  flesh;  but  the  little  patient  continued  throughout  to  take  soft  food,  and 
nothing  occurred  to  create  any  apprehension  as  to  the  completion  of  the  union. 
In  72  hours  the  dressings  and  needles  were  removed;  and,  in  order  to  render  this 
operation  the  more  easy,  a  light  poultice  had  been  laid  over  the  whole,  for 
about  six  hours  previously.  The  union  between  the  divided  surfaces  was  found 
to  be  complete  in  every  part,  even  so  as  to  give  a  perfectly  straight  edge  to  the 
red  border  below;  and  superiorly,  to  close  the  left  fissure  a  little  way  inside  the 
nostril.  The  central  piece  lay  on  the  same  level  with  the  lateral  pieces,  and 
had  become  united  to  them  to  its  very  point,  from  which  down  to  the  edge  of  the 
lip,  there  remained  sufficient  breadth  of  surface  for  firm  adhesion  of  the  lateral 
pieces  at  that  place. 

Simple  dressing  was  applied;  and  the  newly  established  union  carefully  pro- 
tected against  all  lateral  dragging  of  the  cheeks  by  the  use  of  adhesive  plaster. 
The  child  partook  abundantly  of  food,  and,  in  less  than  a  fortnight,  left  hospital 


190  Progress  of  the  Medical  Sciences,  [J"ly 

— the  incisions,  the  needle  marks,  and  even  the  wounded  gums  inside  being  all 
most  satisfactorily  healed.  The  disfig'uring'  breadth  of  the  nose  was  also  much 
reduced;  and  the  mother  had  the  great  gratification  of  observing  that  solids,  and 
even  fluids,  were  swallowed  without  the  least  regurgitation  through  the  nose. 

Case  II.,  of  which  portraits  were  shown,  was  that  of  Maria  Byrne,  three 
months  old,  the  first  offspring  of  young  and  healthy  parents,  admitted  into 
the  City  of  Dublin  Hospital,  December,  1841.  The  fissure  in  the  lip  was  in  the 
left  side  and  single,  but  so  deep  and  wide  that  it  entered  the  nostril  at  the  top, 
and  inferiorly  ran  to  both  angles  of  the  mouth,  leaving  very  little,  free,  red 
border  to  the  lip.  The  palate  bones  were  doubly  cleft,  and,  in  front,  the  right 
maxilla  projected  much  over  the  left. 

The  operation  was  performed  by  Mr.  Houston,  assisted  by  his  colleagues, 
and  Dr.  Beatty.  As  the  central  piece  of  bone  projected  so  far  that  the  lips,  even 
in  their  natural  state,  could  not  be  drawn  over  it,  its  outer  layer,  together  with 
the  pulps  of  the  teeth,  were  removed  as  in  the  former  case,  making  a  flat,  even 
surface  for  the  support  of  the  future  lip.  The  remaining  steps  were  completed 
with  the  same  scissors  and  needles,  as  above  recommended,  and  the  employment 
of  them  was  found  so  far  to  facilitate  the  execution  of  the  operation  that  all  was 
finished  in  less  than  five  minutes.  The  lower  needle  passed  in  such  a  situation 
and  direction,  that  its  point,  in  crossing  from  one  incision  to  the  other,  filled  up 
the  open  mouths  of  the  coronary  artery,  and  thereby  stopped  all  bleeding  from 
it.  The  upper  took  its  hold  so  near  the  nose  as  to  close  the  fissure  in  the  nostril 
and  secure  adhesion  in  that  direction.  The  crossing  of  the  ends  of  the  figure  of 
8  ligatures  held  the  central  parts  in  proper  and  equable  apposition.  The  infant 
appeared  to  suffer  but  little  from  the  operation — a  slight  feverishness,  such  as 
occurred  in  the  former  case,  was  the  only  disturbance  which  followed. 

The  needles  were  withdrawn  at  the  expiration  of  sixty  hours,  and  came  away 
easily,  having  been  loosened  by  suppuration.  The  adhesion  was  firm  and  accu- 
rately correct  in  every  part.  There  was  not  a  single  point  where  freshly-cut 
surfaces  had  been  brought  into  apposition,  at  which  complete  union  had  not  taken 
place.  On  the  very  day  on  which  the  needles  were  removed,  the  infant'  was 
seized  with  acute  bronchitis,  which  lasted  for  three  days,  to  the  imminent  risk 
of  its  life;  nevertheless,  the  union  held  its  ground,  and  after  the  subsidence  of  the 
attack,  a  healing  action  came  over  the  needle  holes,  when  all  got  rapidly  well. 

Mr.  Houston,  in  his  observation  on  these  cases,  remarked  that  there  was  much 
difference  of  opinion  regarding  the  most  safe  and  befitting  periods  for  under- 
taking such  operations.  Some  think  that  the  early  months  of  life  should  not  be 
selected,  on  account  of  the  self-willedness  of  the  infant— the  softness  of  its 
tender  flesh — its  habitude  of  pressing  the  tongue  against  the  lips  as  in  the  act 
of  sucking — its  want  of  power  to  bear  a  few  days  privation  of  food,  and  the  un- 
importance to  a  young  infant  of  the  unsightliness  of  such  a  deformity:— such 
persons  are  still  further  of  opinion,  that  at  the  expiration  of  three  or  four  years, 
shame,  and  a  feeling  of  its  own  infirmity  would  produce  a  desire  on  the  part  of 
the  child  to  submit  to  operation;  that,  at  this  age,  the  tissues  would  have  be- 
come suflSciently  firm  to  bear  needles  or  sutures;  and  that  starvation  for  a  few 
days  would  not  so  much  endanger  success.  On  the  other  hand,  there  are  those 
who  advocate  an  early  operation  on  the  following  grounds: — That  a  grown-up 
child  is  more  unmanageable  than  an  infant;  that  its  conduct  is  more  influenced 
by  fear  of  pain  than  by  hopes  of  good  from  the  operation;  that  the  healing 
powers,  so  far  from  being  more  feeble,  are  more  vigorous  in  the  infant,  than  at  a 
more  advanced  age;  that  the  parts  grow  more  naturally  when  early  put-to-rights, 
than  when  permitted  for  a  time  to  become  mis-shapen;  that  the  nose  ceases  to  be 
so  much  spread  out;  that  the  fissure  in  the  palate,  if  such  exist,  closes  greatly  if 
supported  by  a  firm  and  perfect  lip;  that  bad  habits  of  speaking,  such  as  nasal 
utterance,  which,  if  once  established  becomes  irremediable,  are  prevented;  and, 
lastly,  that  the  feelings  of  parents  are  especially  gratified  by  having  such  de- 
formity repaired  before  their  infant  has  gone  abroad  into  the  world.  But,  al- 
though the  balance  of  advantages  is  thus  evidently  in  favour  of  an  early  opera- 
tion, we  have,  nevertheless,  so  high  authority  as  that  of  Sir  Astley  Cooper  in 


1842.]  ,  Surgery,  191 

favour  of  a  delay,  until  the  child  has  reached  the  age  of  two  years.  He  fears 
convulsions  at  an  earlier  age.  Velpeau  selects  the  first  six  months  of  life;  or, 
if  that  be  passed,  prefers  waiting  until  the  10th  or  15th  year.  Dupuytren's 
favourite  period  was  the  third  month.  Mr.  Houston  observed,  that  from  the 
successful  issue  in  the  case  of  Byrne,  at  the  age  of  three  months,  and  from 
others  to  which  he  adverted  as  having  been  equally  fortunate  in  his  hands  at  the 
same  age,  he  considered  that  to  be  the  age  at  which,  not  only  the  greatest  bene- 
fit may  be  done  by  operation,  but  that,  also,  at  which  there  is  as  much  exemption 
from  fatality  as  at  any  other.  The  operation  may,  no  doubt,  be  undertaken  either 
earlier  in  life  or  later,  if  circumstances  require  it,  and  with  more  or  less  of  benefit; 
but  he  regarded  the  third  month  as  the  most  eligible  period — particularly  in 
cases  where,  as  in  the  above,  the  infant  cannot,  from  deficiency  in  the  palate, 
take  milk  at  the  breast.  Respecting  the  comparative  advantages  of  the  scissors 
or  bistoury  in  such  cases,  the  authorities  for  both  are  nearly  balanced. 

Severinus  and  Louis  among  the  ancients,  with  Listen  among  the  moderns, 
recommend  the  knife:  Desault,  Dubois,  and  others  are  advocates  for  the  scissors, 
whilst  Le  Dran,  and  B.  Bell  have  recourse,  indifferently,  to  one  or  other  of  these 
instruments. 

The  advocates  of  the  bistoury  maintain  that  it  produces  less  pain,  and  makes 
a  neater  wound,  and  one  less  disposed  to  suppurate;  that  the  division  of  the  flesh 
by  scissors,  being  made  more  by  a  pressing  than  by  a  sawing  motion,  the  latter 
consequence  is  the  more  likely  to  follow.  Experience,  however,  does  not  verify 
the  soundness  of  these  views.  Wishing  to  put  the  matter  to  the  test,  Bell  ope- 
rated on  one  side  with  scissors,  on  the  other  side  with  a  bistoury,  without  giving 
notice  of  the  difference.  The  patient,  when  asked  in  which  side  he  felt  most 
pain,  hesitated  at  first,  and  ended  by  saying  that  he  felt  most  in  that  to  which 
the  bistoury  had  been  applied.  Mr.  Houston  stated  that  he  has  used  both  instru- 
ments, and  gives  the  preference  to  the  scissors.  They  require  no  support,  but 
that  given  to  the  lip  by  stretching  it  from  the  angle:  they  remove  in  an  instant, 
the  precise  amount  required;  their  operation  is  not  more  painful  than  that  of  the 
knife;  and,  when  sufficiently  sharp  and  strong,  they  make  a  wound  equally 
capable  and  certain,  of  union  by  the  first  intention.  Regarding  the  amount  of 
lip  to  be  removed,  the  more  usual  error  committed,  is  that  on  the  side  of  de- 
ficiency. The  rounded  corners  at  the  bottom  of  the  fissure  must  be  completely 
cleared  away,  as  otherwise,  no  matter  how  perfect  be  the  subsequent  union,  a 
depression  will  ever  after  remain  to  tell  of  the  original  malformation;  nor  need 
there  be  any  apprehension  about  the  danger  of  removing  too  much,  for  it  is 
singular  how  yielding  the  lip  is,  and  how  much  it  grows  in  accommodation  to 
its  new  condition.  The  drawings  exhibited  illustrated  this  point  very  satisfac- 
torily,— the  free  edge  of  the  upper  lip  being,  in  both,  straight,  and  admitting 
equally  of  perfect  apposition  with  those  of  the  lower  lip.  Mr.  Houston  observed 
that  of  the  many  hare-lips  which,  having  at  some  former  time  been  operated 
upon,  met  the  eye  in  the  streets,  the  upward  dimple  leaving  a  tooth  or  two  ex- 
posed, was  that  which  particularly  attracted  attention. 

The  treatment  to  which  the  central  piece  in  double  hare-lip  is  to  be  subjected, 
must  vary  with  its  size  and  form.  The  plan  adopted  in  the  child  Fox — a  modi- 
fication of  that  recommended  by  M.  Gensoul,  as  opposed  to  that  of  Louis  and 
Heister,  who  operated  only  on  one  side  at  a  time — succeeded  perfectly,  and  with 
a  smaller  number  of  needles  than  are  usually  employed.  A  single  needle  was 
found  sufficient  to  hold  the  central  piece  in  its  place;  although  Velpeau  and 
others  are  in  the  habit  of  inserting,  in  addition  to  the  large  needles  several 
smaller  ones,  called  insect  needles,  or  even  of  pinning  the  central  tubercle  to  the 
bone  underneath  for  the  sake  of  greater  security.  But  Mr.  Houston  is  of  opinion 
that  all  such  extra  needles  are  not  only  unnecessary,  but  prejudicial,  as  being 
calculated  to  irritate  and  inflame  the  already  too  tender  flesh.  The  projecting 
piece  of  maxillary  bone  was  treated  as  above  described,  viz.,  by  paring  off  the 
outer  lamina,  and  removing  the  teeth,  because  the  deformity  which,  in  both  cases, 
it  presented  was  such  as  could  not  be  remedied  by  Desault's  method  of  pushing 
it  into  place  by  a  graduated  pressure  continued  for  some  days  or  weeks.   On  the 


193  Progress  of  the  Medical  Sciences,  [July 

subject  of  needles,  Mr.  Houston  considered  that  the  ordinary  woollen  needle 
possessed  every  requisite  quality,  more  especially  if  pointed  like  the  glover's 
needle.  It  may  be  had  of  any  degree  of  fineness,  and  is  of  sufficient  length 
after  being  deprived  of  its  point  and  edge,  to  present  a  small  polished  surface  to 
the  flesh  in  which  it  is  to  lie.  During  the  operation,  too,  it  is  particularly  ma- 
nageable, as  when  once  introduced  there  is  little  danger  of  its  slipping  out  again, 
even  though  left  untied,  while  the  other  steps  of  the  operation  are  in  progress; 
and  that  the  presence  of  such  is  not  a  source  of  much  irritation  is  shown  by  the 
length  of  time  during  which  they  lay  comparatively  harmlessly  in  the  lip,  viz.: 
seventy-two  hours  in  the  child  of  two  and  a  half  years,  and  sixty  hours  in  that 
of  three  months — a  duration  which,  by  the  way,  may  be  perhaps  as  a  general 
rule  unnecessarily  long,  but  which  was  permitted  in  the  above  cases  for  security 
sake,  encouraged  by  the  absence  of  all  symptoms  of  inordinate  irritation  from 
their  presence. 

Mr.  Houston  concluded  by  observing,  that  after  all  such  operations,  where 
great  nicety  and  perfection  is  aimed  at,  the  strictest  precautions  should  be  taken 
to  guard  against  every  source  of  inordinate  feverish  excitement;  as  under  fever, 
the  lymph  thrown  out  is  not  organized,  and  failure  must  necessarily  be  the  con- 
sequence. He  considered  that,  had  the  bronchitis  and  fever  which  came  on, 
on  the  day  of  the  removal  of  the  needles  in  Byrne's  case,  showed  itself  a  day 
earlier,  the  operation  would  have  been  unsuccessful:  and  it  is  under  the  influence 
of  such  conviction  that  he  is  always  desirous,  especially  in  hospital  practice,  and 
when  the  patient  is  fresh  from  the  country,  of  operating  soon  after  admission,  in 
order  to  have  the  wounds  healed  before  there  be  time  for  any  derangement  of 
health  from  change  of  air,  or  other  sources  of  insalubrity. 

Dr.  Dawson,  of  Dungannon,  has  successfully  operated  for  hare-lip  upon  a 
child  four  days  old.  The  operation  was  performed  on  the  25th  of  January,  and 
on  the  12th  of  March  the  cicatrix  was  scarcely  perceptible,  and  the  sides  of  the 
fissures  in  the  hard  palate  had  become  so  much  approximated  together,  that 
Dr.  D.  thinks  by  making  raw  the  edges  that  he  can  cause  adhesion  between 
them. 

Mr.  John  Peebles  reported  a  case  operated  on  when  the  child  was  three  weeks 
old.  He  "cut  the  edges  with  a  sharp  scissors,  and  united  the  cut  surfaces  with 
two  long  and  fine  worsted  needles  in  the  usual  manner,  and  covered  and  sup- 
ported the  parts  with  adhesive  plaster:  no  bandage  was  required.  In  thirty-six 
hours  I  removed  the  upper  needle,  and  on  the  third  day  the  lower,  as  it  was 
causing  ulceration  by  its  pressure,  when  I  found  the  edges  of  the  incision  united. 
Cold  cream  spread  upon  lint  and  retained  by  two  strips  of  adhesive  plaster,  ex- 
tending from  ear  to  ear,  completed  the  cure  in  a  few  days,  which,  in  fact,  was 
only  delayed  by  the  ulceration  caused  by  the  second  needle." 

"The  satisfactory  termination  of  this  case  proves  the  advantage  of  an  early 
operation.  Very  little  blood  flowed  into  the  mouth;  none  was  swallowed;  the 
child  only  required  four  days  spoon-feeding  after  the  last  needle  was  removed, 
or  seven  from  the  day  of  operation,  and  at  the  end  of  this  time  it  took  the  breast 
freely." 

Mr.  Porter  has  operated  on  a  child  ten  days,  Mr.  Smyly  one  fourteen  days 
old. 

In  operating  at  an  early  age,  it  is  important  to  guard  against  the  little  sufferer 
being  allowed  to  suck  after  the  operation,  as  a  considerable  amount  of  blood 
might  thus  be  swallowed. — Dublin  Medical  Press,  March  2,  23,  and  30,  and 
May  4th,  1842. 

54.  Jlmputation  during  Pregnancy. — Mr.  Tarleton,  of  Birmingham,  relates 
in  the  London  Medical  Gazette,  Dec.  17,  1841,  the  case  of  a  female  27  years  of 
age,  labouring  under  necrosis  of  the  tibia,  and  whose  leg  was  amputated  when 
four  months  advanced  in  pregnancy.  No  unpleasant  symptom  occurred,  the 
wound  healed,  and  she  was  in  due  time  delivered  of  a  fine  boy. 


1842,]  Surgery,  193 

55.  Solution  of  Urinary  Calculi. — M.  Pelouse  read  to  the  Academy  of  Sci- 
ences of  Paris,  March  21st,  a  report  in  the  name  of  M.  Gay  Lussac  and  himself, 
on  various  communications  forwarded  by  M.  Leroy  d'Etioles  on  the  subject  of 
the  solubility  of  urinary  calculi. 

The  author  first  drew  atten'tion  to  the  failures  of  empirical  remedies,  which 
have  been  abandoned  one  after  the  other;  he  then  mentioned  the  proposal  of 
Fourcroy  and  Vanquelin  to  suit  the  nature  of  the  solvents  employed  to  that  of 
the  calculous  concretions;  to  attack  uric  acid  calculi  with  alkalies,  the  phosphate 
and  oxalate  calculi  with  nitric  and  muriatic  acid,  and  to  inject  these  substances 
directly  into  the  bladder.  Latterly,  it  has  been  asserted,  that  the  mucus  which 
seems  to  bind  or  cement  the  calculous  matter  together  is  softened  by  the  action 
of  the  alkaline  carbonates,  and  thus  a  rapid  solution  or  disintegration  of  uric  acid 
calculi  may  be  obtained. 

The  experiments  of  the  reporters  were  of  two  kinds;  some  made  in  the  labo- 
ratory, others  on  the  living  subject.  The  chemical  experiments  proved  that 
alkaline  carbonates  act  rather  on  the  mucus  and  animal  matter,  by  which  the 
particles  of  calculi  are  bound  together,  than  on  the  calculi  themselves.  The 
degree  of  hardness  and  cohesion  of  the  stone  presents  a  much  greater  obstacle 
to  its  solution  than  its  chemical  composition.  The  alkaline  carbonates  act  ex- 
tremely slowly  on  uric  acid  calculi,  even  when  highly  concentrated,  and  at  a 
temperature  of  104^  Fahr.  When  the  calculus  does  not  contain  any  carbonate, 
the  solution  proceeds  infinitely  more  rapidly,  though  the  agent  employed  is 
comparatively  feeble.  Experiments  made  at  one  of  the  mineral  springs  of  Vichy 
furnished  the  same  results,  and,  with  a  few  exceptions,  the  solution  was  equally 
rapid  in  calculi  of  different  kinds.  A  box  divided  into  several  compartments, 
and  pierced  with  holes,  was  allowed  to  remain  during  two  months  in  one  of  the 
springs  at  Vichy.  Numerous  fragments  of  calculi  were  placed  in  this  box.  All 
the  fragments  were  diminished,  and  some  of  them  remarkably  so,  but  none  were 
completely  dissolved;  indeed,  although  none  of  the  original  fragments  weighed 
more  than  180  grains,  when  taken  from  the  box  they  were  all  much  larger  in 
diameter  than  the  urethra.  But,  although  the  solution  goes  on  very  slowly  in 
the  waters  of  Vichy,  it  is  more  marked  than  the  effects  obtained  by  the  alkaline 
carbonates  or  bicarbonates,  and  this  seems  to  depend  on  the  great  quantity  of 
carbonic  acid  contained  in  the  Vichy  waters,  which  acts  mechanically  on  the 
calculi,  and  hastens  their  division. 

Numerous  urinary  calculi,  and  of  various  composition,  were  submitted  during 
twelve  months  to  a  fluid  containing  from  ten  to  twenty  scruples  of  carbonate  or 
bicarbonate  of  potass  and  soda  to  the  quart  of  water,  at  the  ordinary  tempera- 
ture of  the  atmosphere.  None  of  the  calculi  were  dissolved,  and  some  of  theni 
appeared  unchanged  in  size;  the  loss  in  weight  varied  from  one-fourth  to  one- 
half  of  their  original  weight.  Several  fragments  of  calculi,  weighing  from  five 
to  ten  scruples,  and  placed  in  a  glass  funnel,  were  submitted  during  three  months 
to  a  constant  current  of  water,  containing  one-twentieth  of  its  weight  of  carbo- 
nate of  soda.  The  size  of  the  fragments  was  not  diminished  in  an  evident  man- 
ner, but  they  were  all  more  friable;  the  loss  of  weight  varied  from  0.10  to  0.60. 
Very  small  fragments  of  four  to  eighteen  grains  generally  resist  a  saturated 
solution  of  carbonate  of  soda  at  a  temperature  of  86°  to  104°  Fahr.  during 
a  month;  and  the  majority  of  calculi  are  so  tenacious,  that  fragments  not  larger 
than  a  nut  are  not  dissolved  or  disintegrated  until  they  have  been  boiled  for 
several  days  in  water  containing  six  scruples  por  quart  of  bicarbonate  of  soda. 

Instead  of  the  carbonates,  the  borates  of  potass  and  soda,  and  nitric  or  muri- 
atic acids  were  employed,  but  with  the  same  results;  the  borates,  however, 
seemed  to  be  somewhat  more  efficacious. 

The  experiments  now  mentioned  show  how  long  and  difficult  a  process  it  is 
to  effect  the  solution  of  urinary  calculi,  even  out  of  the  bladder,  and  under  the 
most  favourable  circumstances. 

The  second   series  of  experiments  was  made  on  patients,  the  majority  of 
whom,  previously  to  having  undergone  lithotrity,  had  tried  for  several  months 
or  even  years,  alkaline  mineral  waters  or  the  bicarbonates.   It  is  a  matter  of  cer» 
No.  VII.— July,  1842.  17 


194  Progress  of  the  Medical  Sciences.  [July 

tainty  that,  in  a  great  majority  of  cases,  the  use  of  alkaline  remedies  fails  to 
effect  the  solution  of  urinary  calculi;  and  those  authors  were  probably  deceived 
who  announced  the  solution  of  large  calculi  in  a  few  weeks  or  months  under  the 
influence  of  an  alkaline  treatment. 

M.  Leroy  not  only  regards  the  use  of  alkaline  drinks  and  baths  as  generally 
inefficient  for  the  cure  of  urinary  calculi,  but  he  thinks  it  a  dangerous  practice 
to  force  the  kidneys  to  secrete  alkaline  urine  during  a  considerable  length  of 
time.  Many  other  practitioners,  and  amongst  them  M.  Prunelle,  inspector  of 
the  Vichy  springs,  are  of  the  same  opinion.  He  repeats  the  objection  of  Marcet 
and  Prout,  that  the  earthy  phosphates  held  in  solution  by  the  free  acids  of  the 
urine  may  be  precipitated  when  the  acids  are  neutralised,  and  thus  give  rise  to 
the  calculi  containing  the  phosphate  and  carbonate  of  lime  or  magnesia. 

Cases  of  this  kind  occur  in  persons  labouring  under  catarrh  of  the  bladder, 
where  the  urine  is  altered  in  quality  and  retained  in  that  organ:  they  do  not  occur 
under  other  circumstances,  and  the  phosphatic  diathesis  seems  to  be  an  effect  of 
the  inflammatory  affection  of  the  bladder.  The  spontaneous  changes  which  take 
place  in  the  composition  of  urinary  concretions  may  depend  on  the  same  cause; 
thus,  when  the  urine  becomes  ammoniacal  from  inflammation  of  the  bladder,  the 
uric  acid  concretions  are  covered  with  a  layer  of  a  phosphate;  and  hence  the 
great  proportion  of  alternate  calculi,  which,  according  to  Dr.  Prout,  form  one- 
fourth  of  the  whole  number.  M.  Prunelle  has  seen  patients  who  passed  con- 
siderable quantities  of  uric  acid  gravel  almost  immediately  after  taking  the 
alkaline  waters;  in  some  cases  the  quantity  was  such,  that,  if  we  suppose  the 
gravel  to  have  been  formed  in  the  kidneys,  the  latter  must  have  been  larger  than 
the  stomach.  Perhaps  the  use  of  alkaline  remedies  occasions,  in  some  patients, 
an  abnormal  secretion  of  uric  acid,  for  we  know  that  the  presence  of  an  alkali 
often  gives  rise  to  the  formation  of  an  acid. 

As  the  chemical  experiments  had  demonstrated  the  great  difficulty  of  dissolv- 
ing urinary  calculi,  it  was  thought  prudent  to  confine  the  experiments  made  on 
the  living  subject  to  the  fragments  of  stone  which  remained  in  the  bladder  after 
lithotrity.  The  alkaline  carbonates  and  bicarbonates,  the  caustic  alkalies,  bo- 
rax, nitric  and  muriatic  acids,  dissolved  in  water,  were  injected  into  the  bladder 
by  means  of  a  double  syringe,  and  at  a  temperature  of  95°  to  104°  Fahr.;  from 
25  to  250  quarts  of  fluid  were  passed  through  the  bladder  of  the  same  patient  in 
this  way.  Some  of  the  patients  experienced  no  inconvenience  from  the  injec- 
tions, but  the  majority  suffered  so  much  that  it  was  found  necessary  to  discon- 
tinue them.  In  one  solitary  case  the  calculous  fragments  were  dissolved  in  a 
fluid  containing  from  0.04  to  0.05  of  its  weight  of  nitric  acid;  they  were  com- 
posed of  phosphate  of  lime  and  the  ammoniaco-magnesian  phosphate  mixed 
with  a  small  quantity  of  uric  acid.  In  several  cases  the  cohesion  of  the  calculi 
was  considerably  diminished.  250  quarts  of  fluid,  containing  fifteen  scruples 
of  the  bicarbonate  of  soda  to  each  quart,  were  passed  through  the  bladder  in  one 
case;  the  organ  was  healthy,  and  the  nature  and  volume  of  the  calculous  frag- 
ments had  been  previously  ascertained;  they  underwent  no  diminution,  but  be- 
came so  friable  as  to  be  crushed  under  the  slightest  pressure  of  the  instrument. 
In  most  of  the  other  experiments  it  was  either  necessary  to  suspend  the  injec- 
tions, or  they  produced  no  effect  whatever  on  the  volume  or  cohesion  of  the  cal- 
culous fragments. 

Hence,  M.  Pelouse  concludes  that  the  attempt  to  dissolve  urinary  calculi  by 
injection  into  the  bladder,  does  not  lead  to  any  satisfactory  result.  Borax,  and 
the  other  substances  already  mentioned,  were  equally  inefiicacious. 

It  has  been  recently  announced  in  England  that  Benzoic  acid,  mixed  with  a 
small  quantity  of  borax  or  alkaline  carbonate,  is  converted  into  hipuric  acid, 
which  is  found  in  the  urine.  The  experiments  made  by  the  authors  upon  this 
point  were  not  satisfactory;  they  were  never  able  to  detect  the  sliirhtest  trace  of 
hipuric  acid  in  the  urine.  In  many  cases,  however,  they  observed 'that  the  urine 
gave  out  an  agreeable  odour  of  alcohol,  quite  different  from  its  characteristic 
smell,  and  remained  for  several  days  without  undergoing  any  apparent  change 
whatever. —Z^u^'/m  Med.  Fress,  20th  April,  1842. 


1842.]  Surgery.  195 

56.  Cauterization  of  the  neck  of  the  Uterus. — During  the  last  three  months  of 
the  past  year,  M.  Lisfranc  has  made  a  great  number  of  experiments  at  the  hos- 
pital of  La  Pitie,  for  the  purpose  of  determining  what  is  the  best  caustic  that 
can  be  employed  in  cases  where  it  may  be  necessary  to  cauterize  the  neck  of  the 
uterus.  Simple  ulcerations  of  this  organ  require  the  use  of  caustic,  and  it  is 
now  well  ascertained  that  they  are  more  or  less  rapidly  healed  by  this  means. 
Practitioners  are  equally  in  the  habit  of  employing  the  nitrate  of  silver  and  the 
deuto-nitrate  of  mercury,  but  the  circumstances  which  should  guide  us  in  the 
choice  of  either  remedy  have  not  been  pointed  out.  From  the  numerous  expe- 
riments instituted  by  M.  Lisfranc,  it  would  appear  that  hemorrhage  very  rarely 
ensues  after  the  use  of  the  deuto-nitrate,  while  lunar  caustic  frequently  occasions 
more  or  less  abundant  loss  of  blood.  H-ence  it  follows  that,  whenever  ulceration 
of  the  neck  of  the  uterus  is  accompanied,  as  it  often  is,  by  congestion  or  sub- 
inflammation  of  the  organ,  we  must  not  employ  the  nitrate  of  silver,  which  has 
a  tendency  to  increase  the  congestive  state  of  the  uterus. 

During  the  last  three  months  of  the  year  1841,72  cauterizations  were  per- 
formed on  eleven  women  affected  with  ulceration  of  the  neck  of  the  uterus:  in 
44  of  these  operations,  the  nitrate  of  silver  was  used,  and  in  31,  its  employment 
was  followed  by  a  discharge  of  blood;  on  the  other  hand,  the  deuto-nitrate  of 
mercury  was  used  in  28  cases,  and  in  3  only  occasioned  a  slight  discharge. — 
Ibid,  from  Bull,  de  Therap. 

57.  Tesico-vaginal  Fistula. — M.  Leroy  d'EtioUes  read  to  the  Royal  Academy 
of  Medicine  of  Paris,  March  8th,  a  memoir  on  vesico-vaginal  fistulae.  The 
cause  of  the  failures  attending  operations  for  the  cure  of  this  affection  are,  the 
size  of  the  opening,  the  diminished  capacity  of  the  bladder,  the  thinness  of  the 
vesico-vaginal  septum,  and  the  injurious  action  of  the  urine. 

When  the  fistula  is  small,  it  often  heals  up  spontaneously;  if  a  little  larger, 
much  benefit  will  be  derived  from  the  employment  of  the  actual  cautery,  but  the 
present  mode  of  applying  this  remedy  is  faulty.  The  tumefaction  of  the  edges 
of  the  fistula,  caused  by  the  cautery,  closes  the  opening  for  a  few  days;  but  the 
cauterized  parts  soon  come  away,  the  tumefaction  ceases,  and  the  opening  is 
re-established.  M.  Leroy  proposes  to  apply  the  cautery  at  two  different  peri- 
ods; by  the  first  application  he  would  merely  bring  the  edges  of  the  fistula  in 
contact;  by  the  second  he  excites  an  adhesive  inflammation  in  the  parts. 

When  the  fistulous  opening  is  large,  the  cautery  fails,  and  we  must  have 
recourse  to  other  means.  As  the  chief  obstacles  are  the  thinness  of  the  vesico- 
vaginal wall  and  the  contact  of  urine,  M.  Leroy  proposes  to  raise  up  the  wall  of 
the  vagina,  and  apply  it  over  the  opening;  this,  however,  can  only  be  done  when 
the  fistula  occupies  the  middle  of  the  vesico-vaginal  septum. 

For  very  large  perforations,  the  only  remedy  seems  to  be  an  autoplastic  ope- 
ration. The  method  of  M.  Jobert  almost  always  fails,  from  mortification  of  the 
long  flaps  taken  from  the  labia  or  thigh.  The  arched  flap  of  M.  Velpeau  is 
obtained  with  great  difficulty.  The  author  proposes  to  take  the  flap  from  the 
posterior  wall  of  the  vagina;  he  commences  his  incision  below  the  fourcheite^ 
divides  the  cellular  tissue  which  unites  the  vagina  to  the  rectum,  and  stops  at 
the  point  where  the  union  between  the  two  walls  becomes  intimate;  a  short, 
wide,  and  thick  flap  is  thus  obtained  and  applied  over  the  fistulous  opening. 
Finally,  there  are  cases  which  do  not  admit  of  being  relieved  by  any  operation 
whatever.  In  these  unfortunate  circumstances,  the  author  proposes  to  plug  the 
vagina  with  a  layer  of  Indian  rubber,  which  is  free  from  the  inconveniences 
attending  all  attempts  at  permanent  plugging  hitherto  made. — Ibid. 

58.  Hernia  of  the  Stomach. — A  woman,  aged  between  60  and  70,  had  three  days 
before  been  taken  with  vomiting  of  a  thick  blackish  liquor,  which  was  thrown 
up  in  considerable  quantities.  She  was  cold,  the  vital  forces  depressed,  the 
pulse  weak  and  low.  The  tongue  was  black,  with  a  thick  moist  fur.  She  had. 
had  for  many  years  an  umbilical  rupture,  as  large  as  a  man's  head.  She  had 
before  experienced  two  attacks  of  the  same  kind,  but  less  severe  and  serious. 


196  Progress  of  the  Medical  Sciences.  [J"ly 

On  examining  the  umbilical  tumour,  I  found  it  in  no  degree  tense,  nor  was  it 
particularly  tender  or  uneasy  on  being  handled,  but  its  contents  I  could  not  re- 
turn or  lessen.  The  belly  was  soft,  and  in  no  degree  sore  on  pressure.  I 
viewed  the  case  as  one  of  haematemesis,  and  recommended  astringents,  with 
opium  and  stimulants.  The  patient  died  in  twelve  hours.  K  post-mortem  dis- 
closed more  than  half  the  stomach,  of  three  times  the  natural  thickness,  in  the 
sac,  together  with  omentum  and  colon.  The  neck  of  the  sac  was  very  large;  the 
contents  of  the  sac  had  not  been  strangulated;  they  were  not  in  the  least  dis- 
coloured. There  was  an  abrupt  line  at  which  the  natural  texture  of  the  stomach 
terminated,  and  the  thickened  portion  commenced;  the  latter  must  have  been  out 
of  the  abdomen  for  years. — Lond,  Med.  Gaz.,  Feb.  1842. 

59.  Rare  form  of  Internal  Strangulation. — Prof.  Geoghegan  communicated 
to  the  Surgical  Society  of  Ireland  the  following  example  of  this. 

A  female,  aetat.  about  40  years,  was  admitted  March  23d,  into  the  Adelaide 
Hospital,  labouring  under  symptoms  of  alvine  obstruction  of  three  days'  stand- 
ing, which  had  commenced  by  pain  about  the  umbilicus,  followed  by  bilious 
vomiting;  in  addition  to  the  above  symptoms,  the  following  were  noticed  on 
admission: — Constipation,  tense  and  tympanitic  abdomen,  which  vyjas  slightly 
tender  a  little  above  the  umbilicus  on  the  relaxation  of  pressure,  anxious  counte- 
nance, hiccup,  and  accelerated,  yet  firm  pulse.  A  careful  examination  failed  to 
detect  any  hernial  protrusion.  Notwithstanding  the  energetic  employment  of 
appropriate  means,  the  symptoms  continued  to  increase  in  intensity,  (with  tri- 
vial remissions.)  the  vomiting,  previously  bilious,  assumed  a  stercoraceous  cha- 
racter, both  as  to  appearance  and  odour,  and  about  forty-eight  hours  before  death, 
obvious  indications  of  peritonitis  had  supervened — the  patient  succumbed  on  the 
twelfth  day  of  her  illness.  It  appeared  that  about  eight  years  previously,  she 
had  had  an  attack  of  a  similar  character,  which  persisted  for  five  weeks^  and 
finally  subsided  under  the  employment  of  calomel  and  blisters.  The  treatment 
was  directed  to  the  removal  of  intestinal  obstruction,  and  the  prevention  of 
inflammatory  action,  and  consisted  in  the  employment  of  injections  administered 
with  the  long  tube,  purgatives,  mercurials,  &c. 

On  dissection  the  cause  of  the  mischief  proved  to  be  a  constriction  of  the 
ileum,  by  the  vermiform  appendage  of  the  coecum,  which,  together  with  a  band 
of  condensed  fatty  and  cellular  membrane  derived  from  the  posterior  aspect  of 
the  latter  intestine,  had  passed  in  front,  and  encircled  it  about  two  inches  from 
its  termination:  the  vermiform  appendix  was  converted  into  a  sort  of  ligamen- 
tous cord,  and  its  cavity,  except  for  about  half  an  inch  from  its  commencement, 
obliterated;  having  passed  around  the  ileum,  it  terminated  by  attaching  itself  to 
a  sac  of  a  reddish  black  colour,  of  cylindrical  form,  and  about  the  size  of  the 
gall-bladder.  This  sac  was  invested  by  peritoneum,  except  on  its  posterior 
surface,  which  was  attached  to  the  iliac  fossa,  its  walls  were  thick  and  fibrous 
externally,  internally  lined  by  a  smooth  membrane,  between  which  and  the 
external  tunic,  there  was  at  its  upper  part  a  laminated  texture:  there  were  also 
a  few  small  patches  of  bony  deposition  on  the  inner  surface — the  cavity  was 
filled  by  a  dark  red  matter  of  the  consistence  of  stiif  jelly,  and  presented  in  its 
back  part  a  small  excavation  opening  on  the  iliac  fascia,  by  an  orifice  in  the 
fibrous  investment  of  the  sac — the  intestinal  tract  above  the  stricture  presented 
unequivocal  marks  of  peritoneal  inflammation,  and  was  distended  with  flatus 
and  fluid  faeces,  its  mucous  coat  was  also  congested,  and  of  a  reddish  gray 
colour,  with  some  submucous  infiltration — the  strangulated  portion  of  the  ilium 
was  coated  with  lymph,  and  its  parietes  considerably  thickened,  and  at  its  termi- 
nation in  the  ccecum  extremely  brittle,  the  latter  intestine  was  also  partially 
coated  with  lymph;  the  colon  contained  a  few  scybala,  and  was  uninflamed. 
As  to  the  mode  in  which  the  vermiform  appendage  insinuated  itself  around  the 
small  intestine,  it  would  be  useless  to  speculate.  Dr.  G.  observed  that  the 
case  was  one  which,  ex  necessitate  rei,  must  have  bid  defiance  to  treatment;  it, 
however,  suggested  one  practical  consideration,  that  in  similar  instances  the 
occurrence  of  previous  attacks  of  intestinal  obstruction,  should  not  necessarily 


1842.]  Ophthalmology.  197 

lead  to  the  conclusion,  that  the  obstructing  cause  is  not  of  a  permanent  organic 
character.  Peritonitis  is  not  necessarily  present  in  fatal  cases  of  obstruction  of 
the  bowels,  nor  when  present,  is  it  the  sole  cause  of  death,  which  is  perhaps 
chiefly  to  be  attributed  to  the  exhaustion  produced  by  frequent  vomiting,  &c. 
Dr.  G.  has  met  cases  of  fatal  obstruction,  in  which  there  was  scarcely  a  trace 
of  peritonitis. — Dublin  Medical  Press,  April  20,  1842. 


OPHTHALMOLOGY. 

60.  On  certain  structures  in  the  Orbit,  and  an  improved  method  of  treating  its 
Diseases.  By  J.  M.  Ferrall,  Esq.— One  of  the  most  interesting  papers  which 
have  lately  appeared  in  the  British  Journals,  is  this  by  Mr.  Ferrall.  It  places 
in  a  new  light  some  most  interesting  appendages  of  the  eye,  and  enables  us  to 
treat  some  of  its  diseases  with  more  confidence  than  we  have  hitherto  been  able 
to  do.  In  the  year  1835,  Mr.  Ferrall  was  called  to  see  a  patient  labouring  under 
a  most  painful  affection  of  the  eye.  He  had  been  without  sleep  for  more  than 
forty-eight  hours.  The  pain  was  in  the  ball  of  the  eye,  forehead,  and  temple, 
and  of  a  most  racking  and  intense  kiwd.  The  eye  evidently  projected  three 
quarters  of  an  inch  beyond  its  fellow;  the  lids  were  swollen  and  oedematous,and 
of  a  dusky  red  colour.  The  conjunctiva  of  the  globe  was  protruded  all  round 
the  cornea  in  the  manner  of  chemosis,  but  its  colour  was  not  red  nor  vascular; 
it  had  a  pale  amber  colour  and  manifestly  was  distended  by  serous  infiltration. 
The  cornea  and  iris  were  perfectly  healthy. 

Bleeding  and  other  severe  antiphlogistic  treatment  greatly  relieved  for  a 
time,  but  he  was  not  permanently  relieved  till  the  system  had  been  affected  with 
calomel. 

Now,  what  was  this  affection'?  The  eye  was  perfectly  healthy,  the  disease 
was  evidently  in  the  appendages.  There  was  neither  corneitis,  sclerotitis,  iritis, 
nor  retinitis.  At  first  sight  it  seemed  like  periostitis,  but  one  difficulty  presented 
itself  to  this  explanation;  when  the  upper  third  of  the  superior  eyelid  was 
pressed  in  such  a  manner  that  the  pressure  was  directed  backwards  towards  the 
apex  of  the  orbit,  the  sufferings  were  greatly  increased;  but  when  it  was  di- 
rected upwards  towards  the  periosteal  covering  of  the  roof  of  the  orbit,  the  patieni 
did  not  complain.  Besides,  periostitis  would  hardly  produce  this  projection  of 
the  eye.  On  account  of  the  difficulty  of  coming  to  a  just  conclusion  on  the 
nature  of  this  case,  Mr.  Ferrall  resolved  to  examine  the  anatomy  of  the  eyeball 
more  minutely.  He  found  that  a  distinct  sheath  existed  around  the  globe,  which 
protected  it  from  the  unnecessary  action  of  the  muscles,  and  also  assisted  the 
muscles  in  their  offices;  and  it  was  evidently  this  sheath,  which  he  names  the 
Tunica  Vaginalis  Oculi,  which  was  affected  in  the  foregoing  case.     He  says: 

"  Having  separated  the  divided  conjunctiva,  we  expose,  not  as  has  been  de- 
scribed by  anatomists,  a  cushion  of  adipose  tissue,  but  a  distinct  tunic  of  a  yel- 
lowish white  colour,  and  fibrous  consistence,  continuous  in  front  with  the  pos- 
terior margin  of  the  tarsal  cartilage,  and  extending  backwards  to  the  bottom  or 
apex  of  the  orbit,  where  its  consistence  becomes  less  strongly  marked.  By 
proceeding  in  the  manner  I  have  mentioned,  the  parts  are  displayed  without  any 
elaborate  dissection.  The  sharp  end  of  a  probe,  or  director,  will  be  sufficient  to 
separate  the  ball  of  the  eye  from  the  new  organ,  by  breaking  gently  the  fine  cel- 
lular tissue  which  connects  them.  Its  colour  is  totally  different  from  that  be- 
longing to  its  external  surface,  and  it  is  here  perfectly  smooth,  where  the  eye 
glides  over  it  in  its  movements.  The  muscular  substance  of  the  recti  muscles 
is  nowhere  visible,  they  lie  on  the  outside  of  this  tunic,  which  insulates  and 
protects  the  eye  in  the  most  perfect  manner. 

"The  most  beautiful  portion  of  this  mechanism,  however,  remains  to  be  de- 
scribed. In  the  concavity  of  this  tunic,  and  about  half  an  inch  posterior  to  its 
anterior  or  orbitar  margin,  are  to  be  found  six  well  defined  openings,  through 
which  the  tendons  of  the  vessels  emerge  in  passing  to  their  insertion  in  the 

17* 


198  Progress  of  the  Medical  Sciences.  [July 

sclerotic  coat,  and  over  which  they  play,  as  over  pulleys,  in  their  course.  The 
tendons  are  loosely  connected  to  the  edges  of  those  apertures  by  fine  cellular 
tissue,  which  opposes  no  obstacle  to  their  gliding  movements. 

*'  The  physiology  of  this  tunic,  which  I  have  ventured  to  term  the  tunica  vagi- 
nalis oculi,  will  be  conveniently  considered  in  relation  to  each  of  its  separate 
offices,  namely,  as  an  investment  and  protector  of  the  globe  of  the  eye,  and  as 
regulating  the  direction  in  which  the  muscles  of  the  eye  are  to  exert  their  force. 
In  either  of  those  capacities,  this  new  and  beautiful  apparatus  (independent  of 
its  pathological  importance)  appears  to  possess  a  physiological  interest,  entitling 
it  to  a  high  place  among  the  many  evidences  of  design,  with  which  the  animal 
frame  abounds. 

'*  The  uses  of  this  tunic,  as  a  covering,  wull  be  obvious  from  a  brief  considera- 
tion of  the  inconveniences  to  which,  without  this  protection,  the  eye  would  be 
subjected  during  the  action  of  its  muscles.  These  muscles,  it  has  been  inva- 
riably taught,  were  in  close  contact  with  the  globe  of  the  eye,  on  their  passage 
to  their  insertion,  the  interspaces  being  occupied  by  the  fat  of  the  orbit.  This 
description  of  the  parts,  which  is  to  be  found  in  the  works  of  the  best  authors, 
implies,  that  during  the  frequent  action  of  its  muscles,  the  eye  must  sustain  a 
pressure  as  great  and  as  suddenly  applied,  as  the  movements  of  the  organ  are 
rapid  and  energetic. 

*'  Now,  according  to  the  received  anatomy  of  the  orbit,  the  globe  of  the  eye  is 
grasped  by  the  recti  muscles  in  such  a  manner,  that  they  must,  during  their 
action,  exert  upon  it, a  sudden  pressure  analogous  to  that  described  by  Sir 
Charles  Bell.  And  when  we  consider,  that  between  their  origin  and  insertion 
they  include  the  most  prominent  portion  of  the  eyeball,  it  is  obvious  that  the 
sudden  swelling  of  their  bellies  during  their  action,  (proverbially  known  to  be 
as  quick  as  thought,)  must  have  produced  a  flash  of  light,  if  no  protective  par- 
tition had  existed  between  them.  The  use,  then,  of  this  tunic  as  a  covering  ap- 
pears to  be,  to  separate  the  eyeballfrom  its  muscles,  and  to  protect  it  from  pressure 
during  ihtir  action.^^ 

Another  office  of  this  tunica  vaginalis  oculi  is  to  assist  the  muscles  by  means 
of  the  openings  through  it,  acting  like  so  many  pulleys,  and  thereby  enabling 
the  recti  muscles  to  act  with  more  power  and  rapidity  in  the  different  motions  of 
the  eye;  and  at  the  same  time  it  prevents  these  muscles  from  retracting  the  eye 
— for  "certainly  if  this  tunic  had  no  existence,  it  would  be  difficult  to  imagine 
how  the  recti  muscles  could  communicate  the  rotatory  movements  to  the  eye 
without  in  a  greater  degree  exerting  a  retracting  power,"  The  human  eye  has 
never  been  seen  to  be  retracted,  but  wAz/ has  never  been  explained  before.  Retrac- 
tion takes  place  in  many  of  the  lower  animals  by  means  of  an  especial  muscle — 
the  retractor  muscle;  but  this  is  fixed  into  the  globe  ?Li  its  posterior  part,  near 
the  entrance  of  the  optic  nerve,  and  cannot  therefore  exercise  any  injurious  pres- 
sure on  the  globe.  This  tunica  vaginalis  oculi  having  been  discovered,  we  are 
better  able  to  understand  some  hitherto  inexplicable  diseases.  The  following 
case  illustrates  what  Mr.  Ferrall  calls  "Rheumatic  inflammation  of  the  tunica 
vaginalis  oculi,"  with  protrusion  of  the  eye. 

"Laurence  Grant,  sstat.  32,  a  carpenter,  of  dark  complexion,  and  rather  strong 
constitution,  presented  himself  at  St.  Vincent's  Hospital,  in  February,  1838,  on 
account  of  violent  inflammation  and  protrusion  of  the  right  eye.  The  globe  of 
the  eye  projected  considerably  beyond  its  natural  situation;  the  cornea  and  iris 
were  healthy  in  appearance,  but  vision  was  much  confused.  The  conjunctiva 
projected  remarkably  around  the  cornea,  but  its  colour  was  pale  amber,  and 
without  any  trace  of  vascularity.  The  eyelids  were  both  swollen  and  red;  the 
lower  part  of  the  upper  lid  was  so  much  tumefied,  that  the  eiliae  appeared  to 
grow  at  an  unusual  distance  from  each  other;  and  its  transverse  diameter  was 
considerably  increased.  The  colour  of  the  lid  was  of  a  dusky  red,  and  its  sur- 
face was  marked  by  a  number  of  distended  veins.  Although  the  swelling  of 
the  palpebra  had  increased  its  vertical  diameter,  and  caused  it  to  descend,  the 
protrusion  of  the  eyeball  was  so  great  as  to  cause  it  to  be  uncovered.  From  the 
superciliary  ridge  to  the  inflamed  portion  of  the  eyelid,  an  interval  could   be 


1842.]  Ophthalmology.  199 

seen,  where  neither  redness  nor  swelling  existed.     This  space  was  about  half 
an  inch  broad,  and  extended  the  whole  length  of  the  lid  transversely. 

"  He  complained  of  agonizing  pain  in  the  ball  of  the  eye,  and  felt  as  if  it  were 
'  dragged  out  of  the  socket.'  This  latter  sensation  he  described  as  never 
ceasing;  but  the  pain  was  liable  to  severe  exacerbations.  He  seemed  to  derive 
some  comfort  from  keeping  the  palm  of  his  hand  pressed  moderately  against  the 
whole  tumour,  although  Ire  could  not  bear  the  finger  of  another  to  be  laid  upon 
it.  The  upper  portion  of  the  superior  palpebra,  which  was  free  from  redness, 
could  however  bear  pressure,  provided  it  was  not  made  suddenly,  or  so  as  to 
shake  the  whole  lid,  and  that  the  pressure  was  directed  upwards  towards  the 
roof  of  the  orbit.  When  asked,  he  admitted  that  he  perceived  an  occasional 
flash  of  light  before  his  eye;  but  this  appearance  was  more  frequent  in  the  be- 
ginning of  the  attack.  It  was  now  five  days  since  the  complaint  commenced. 
He  went  to  bed  free  from  pain  in  the  eye,  and  was  disturbed  about  three  o'clock 
in  the  morning.  He  had  been  unable  to  work  for  the  last  week  from  rheumatism 
in  his  knees  and  legs;  the  limbs  were  improving  at  the  period  of  the  recent 
attack.  He  had  rubbed  the  parts  affected  with  turpentine,  but  had  used  no  in- 
ternal remedy.  There  was  still  remaining  slight  fulness  from  effusion  into  the 
capsule  of  the  left  knee-joint,  and  tenderness  with  tumefaction  about  the  middle 
of  the  right  tibia. 

"This  man  had  suffered  severely  from  syphilis  six  years  before,  and  had  used 
mercury  largely.  He  was  now  married,  but  his  habits  of  intemperance,  as  re- 
garded the  use  of  ardent  spirits,  were  little  altered. 

"The  temporal  artery  was  opened,  and  sixteen  ounces  of  blood  removed,  with 
relief.  The  improvement  however  was  transient,  and  the  pain  returned  almost 
immediately.  The  hospital  being  quite  full  at  the  time,  and  his  lodging  near, 
and  not  uncomfortable,  he  was  allowed  to  take  his  medicine  at  home.  Calomel 
and  opium,  three  grains  of  the  former,  and  half  a  grain  of  the  latter,  were  ad- 
ministered every  third  hour. 

"  There  was  very  little  amendment  until  the  constitutional  effects  of  the  remedy 
were  established.  This  happened  on  the /ourth  day,  when  the  disease  began 
to  give  way.  The  pain  first  diminished,  the  eye  then  receded,  and  the  redness 
gradually  disappeared.  The  tumid  condition  of  the  palpebra,  and  the  distorted 
appearance  of  the  eyelashes,  were  the  last  to  yield.  When  the  disease  in  the 
orbit  was  removed,  it  was  found  that  the  tenderness  and  swelling  of  the  knee 
and  tibia  were  also  gone." 

The  following  case  illustrates  rheumatic  inflammation  of  the  tunica  vaginalis 
oculi,  protrusion  of  both  eyes  consecutively,  and  cure  by  hydriodate  of  potass: 
"Mary  Smyth,  aetat.  48,  was  admitted  into  Joseph's  ward,  April  16,  1840,  on 
account  of  rheumatism,  with  effusion  into  the  capsules  of  both  knee-joints.  She 
was  a  fat,  unwieldy  person,  and  was  rendered  quite  helpless  by  the  synovitis, 
although  enjoying  tolerable  health  before  the  attack.  No  other  joint  was  affected, 
and  she  was  free  from  fever.  Some  degree  of  restlessness  attended  the  pain; 
and  the  renal  secretion  was  scanty  and  high  coloured.  Fomentations  were  em- 
ployed after  the  application  of  leeches,  and  colchicum  administered  internally. 
At  the  end  of  a  week,  and  when  the  swelling  was  nearly  gone,  she  complained 
of  acute  pain  in  the  right  eye.  There  was  no  appearance  of  inflammation  dur- 
ing the  first  twenty-four  hours,  and  it  consequently  attracted  little  attention, 
except  that  an  active  cathartic  was  exhibited.  On  the  second  day,  the  upper 
eyelid  was  inflamed  and  swollen,  and  the  ball  of  the  eye  was  observed  to  project 
a  little;  the  pain  was  increased,  and  she  was  annoyed  by  occasional  flashes  of 
light  before  the  eye.  Blood  was  taken  from  the  temple  by  cupping,  and  anti- 
monials  with  purgatives  were  prescribed.  She  passed  a  wretched  night,  suf- 
fering great  agony;  and  the  next  day,  the  phenomena  of  the  disease  were  fully 
developed.  The  eyeball  projected  three  quarters  of  an  inch;  the  cornea  and  iris 
were  healthy,  and  looked  brilliantly  clear  in  the  midst  of  a  very  prominent  che- 
mosis.  The  colour  of  the  latter  was  a  yellow  amber,  without  any  vascularity 
or  redness.  The  lids  were  swollen  but  did  not  cover  the  eye:  the  upper  lid 
presented  the  dusky-red  colour  and  tumid  appearance  described  in  the  last  case. 


200  Progress  of  the  Medical  Sciences.  [^"^7 

The  superior  portion  of  its  surface,  or  that  next  the  superciliary  ridge,  did  not 
participate  in  this  change,  and  the  two  portions  were  separated  by  a  very  abrupt 
line  of  demarcation.  Pressure  on  the  upper  division,  when  directed  upwards 
towards  the  roof  of  the  orbit,  produced  no  pain.  She  could  see  as  distinctly 
with  the  affected  eye  as  with  the  other.  The  resemblance  to  the  other  cases 
was  too  striking  to  be  overlooked;  and  as  it  was  obviously  not  an  affection  of 
the  periosteum  of  the  orbit,  and  yet  was  connected  with  rheumatism,  there  could 
be  little  hesitation  in  making  a  diagnosis.  I  was  desirous  to  know  whether  any 
other  fibrous  tissue  was  engaged,  and  therefore  requested  Mr.  M'Svveeney,  the 
gentleman  who  noted  the  case,  to  uncover  the  tibiae.  Here,  although  she  had  not 
noticed  it  to  us,  we  found  distinct  swelling,  and  great  tenderness  over  the  left 
tibia,  about  an  inch  below  its  upper  end.  She  then  admitted  that  it  gave  her 
considerable  pain,  but  her  sufferings  in  the  eye  were  so  much  greater,  that  she 
disregarded  it  altogether. 

"  Being  at  this  time  satisfied,  from  researches*  already  published,  of  the  supe- 
rior efficacy  of  the  hydriodate  of  potass  in  periostitis,  I  determined  to  trust  to  it 
alone  in  combating  this  formidable  disease;  but  as  the  organ  of  vision  was  in 
danger,  I  directed  that  this  powerful  salt  should  be  administered  at  shorter  in- 
tervals than  usual.     Ten  grains  were  given  every  third  hour. 

"At  visiting  hour  next  day,  she  had  taken  seventy  grains  of  the  hydriodate. 
She  declared  herself  better,  and  suffered  much  less  pain,  but  we  could  not  per- 
ceive much  difference  in  the  eye.  On  the  day  following,  however,  every  person 
who  saw  her  was  struck  with  the  improvement:  the  whole  tumour  was  greatly 
reduced;  the  ball  of  the  eye  had  receded  considerably;  the  chemosis  was  les- 
sened, and  the  swelling  as  well  as  redness  of  the  lids  was  diminished.  On 
the  fifth  day  from  the  commencement  of  the  treatment,  there  was  hardly  any 
trace  of  the  complaint,  and  the  medicine  was  therefore  discontinued.  The  tibia 
had  now  also  recovered  its  healthy  state,  when,  just  as  we  congratulated  our- 
selves on  the  rapid  subsidence  of  so  severe  an  affection,  the  left  eye  became  the 
seat  of  pain,  and  in  thirty-six  hours  presented  all  the  symptoms  of  the  disease. 
The  same  protrusion  of  ihe  eyeball,  the  same  chemosis  and  swelling  of  the  pal- 
pebras,  and,  as  in  the  previous  attack,  the  same  integrity  of  vision  and  intole- 
rance of  light.  The  hydriodate  of  potass  was  resumed  in  doses  of  fifteen  grains 
every  third  hour,  with  a  resolve  to  persist  in  its  use  (if  it  succeeded)  for  some 
days  after  the  disease  appeared  to  be  removed. 

*'  On  the  day  following,  I  had  the  satisfaction  to  perceive  that  the  symptoms 
had  received  a  check;  and  in  three  days  more,  to  find  them  altogether  nearly 
removed.  The  hydriodate  was  continued  in  diminished  doses,  and  gradually 
lengthened  intervals,  for  ten  days  after  every  symptom  had  disappeared. 

"  Protrusion  of  the  eyeball,  which,  when  attempted  to  be  explained  by  uncom- 
plicated periostitis,  requires  some  stretch  of  imagination,  appears  a  very  simple 
and  inevitable  result  of  inflammation  of  the  tunica  vaginalis  oculi.  There  are 
here  no  soft  parts  to  receive  and  divide  the  pressure,  or  protect  the  globe.  The 
tunic  is  supported  by  other  fibrous  layers  on  its  outside,  as  well  as  by  the  mus- 
cles of  which  they  constitute  the  sheaths.  Inflammation  of  this  capsule  must 
then  be  immediately  followed  by  pressure;  and  when  we  recollect  its  conical 
form,  and  that,  as  happens  in  the  case  of  inflammation  of  other  fibrous  tissues, 
eflfusion  at  once  takes  place  into  the  cellular  membrane  connecting  it  to  the  ball 
of  the  eye,  we  perceive  there  is  nothing  to  prevent  the  dislocation  of  the  latter. 

"This  effusion  into  the  cellular  tissue  will  make  itself  evident  in  another  way. 
The  conjunctiva  at  the  place  where  it  forms  the  fold,  in  being  reflected  from  the 
eyelid  to  the  eye,  closes  up  the  tunica  vaginalis  in  front.  At  this  point  it  will 
not  only  receive  the  pressure  of  the  effused  serum,  but  will  become  separated 
from  its  connection  with  the  sclerotic  coat,  by  the  extension  of  the  infiltration; 
hence  the  amber  coloured  chemosis  without  vascularity  of  the  conjunctiva. 
Chemosis  originating  in  conjunctivitis  always  presents,  in  addition  to  serous 
infiltration  beneath,  one  or  other  of  the  forms  of  hyperaemia.     The  chemosis  of 

*  Medical  Gazette,  April  10,  1840. 


1842.]  Ophthalmology.  201 

which  we  treat  is,  in  uncomplicated  cases,  the  consequence  of  effusion  from  a 
deeper  source.  [  can  easily  imagine  the  extension  of  inflammation  from  the 
fibrous  structures  of  the  lid,  to  its  conjunctival  surface,  and  thence  to  the  scle- 
rotic conjunctiva;  bat  this  complication  did  not  occur  in  the  cases  which  I 
have  related. 

"  In  distinguishing  those  cases,  I  would  not  be  supposed  to  mean,  that  inflam- 
mation of  this  tunic  is  a  disease  apart,  and  never  combined  with  a  similar  condi- 
tion of  the  periosteum  or  cellular  tissue,  on  the  one  hand,  or  inflammation  of  the 
eyeball  itself,  on  the  other.  I  am  aware  they  may  exist  together,  for  I  have 
seen  such  cases.  All  I  mean  to  assert  is,  that  inflammation  of  the  tunic  de- 
scribed, may  be  the  primary  aflfection,  and  the  point  of  departure  from  w^hich  the 
diseased  action  may  spread  to  the  other  fibrous  layers  in  the  orbit,  and  finally 
reach  the  periosteum;  and  that  the  attack  may  even  be  limited  to  the  tunica 
vaginalis  oeuli — that  it  may  here  produce  a  train  of  symptoms  of  the  most  dan- 
gerous kind,  and  which  have  been  hitherto  supposed  to  reside  in  the  periosteum, 
because  the  existence  of  other  fibrous  membranes  in  the  cavity  was  not  sus- 
pected." 

Mr.  Ferrall  shows  the  value  of  being  acquainted  with  the  anatomical  struc- 
ture he  has  described,  in  other  cases,  such  as  "adhesion  of  the  tunica  vaginalis 
to  the  globe  of  the  eye  from  inflammation,"  "abscess  between  the  tunic  and  the 
globe,"  "  tumours  within  the  tunica  vaginalis  oculi;"  and  lastly  in  the  "  extir- 
pation of  the  globe."  Respecting  this  last  operation  he  makes  the  following 
valuable  remarks. 

"The  comparative  safety  of  an  operation  limited  by  this  fibrous  tunic  is  obvious, 
but  an  additional  recommendation  will  be,  the  facility  of  its  performance.  The 
conjunctiva  being  freely  divided,  the  six  tendons  may  be  snipped  across  with  a 
scissors  one  after  another,  where  they  emerge  from  the  tunic.  The  eyeball  will 
then  be  easily  detached  by  a  probe  or  director  passed  freely  around  it;  when  one 
step  alone  would  remain — the  division  of  the  optic  nerve.  When  we  recollect 
that  the  roof  of  the  orbit  is  occasionally  found  to  be  as  thin  as  paper  in  some 
parts,  it  will  appear  most  desirable  to  avoid  stripping  it  of  its  coverings,  by 
operating  within  this  second  orbit,  or  proper  fibrous  socket  of  the  eye." 

Mr.  Ferrall  ends  his  interesting  paper  by  the  following  summary. 

"The  reflections  suggested  by  a  review  of  the  cases  which  led  to  the  present 
inquiry,  as  well  as  of  this  new  and  curious  mechanism  itself,  may  be  reduced  to 
the  following  propositions: — 

1st.  That  the  description  of  anatomists,  which  places  the  globe  of  the  eye  in 
contact  with  the  fat  and  muscles  of  the  orbit,  is  erroneous. 

2d.  That  there  exists  a  fibrous  tunic,  investing  and  insulating  the  eyeball, 
and  separating  it  from  all  the  other  structures  in  the  orbit. 

3d.  That  the  uses  of  this  tunica  vaginalis  oculi  are,  to  present  a  smooth  sur- 
face, facilitating  the  movements  of  the  eye;  and  by  its  density  and  tension,  to 
protect  it  from  the  pressure  incidental  to  the  swelling  of  its  muscles  during  their 
action. 

4th.  That  the  openings  in  this  tunic  perform  the  oflice  of  pulleys,  giving  a 
proper  direction  to  the  force  exerted  by  the  muscles, — securing  the  motions 
of  rotation,  and  opposing  those  of  retraction,  which  would  otherwise  pre- 
dominate. 

5th.  That  certain  cases  of  disease  within  the  orbit,  accompanied  by  protrusion 
of  the  eyeball,  are  to  be  explained,  only  by  reference  to  the  tunica  vaginalis 
oculi,  and  the  other  fibrous  tissues  now  described. 

6th.  That  a  correct  knowledge  of  the  anatomy  of  the  orbit  and  of  the  fibrous 
structures  alluded  to,  is  essential  to  the  operating  surgeon,  in  dealing  with  ab- 
scesses and  tumours,  in  extirpation  of  the  eyeball,  in  the  operation  for  strabismus., 
and  all  operations  on  that  cavity." — Braithwaite' s  Retrospect^  No  IV,  from  Dub- 
lin Journ.  Med.  Sci.  July  1841. 

61.  Rupture  of  the  Sclerotica  by  a  blow  ivith  the  Fist. — John  Hays,  aged  39, 
was  admitted  into  Middlesex  Hospital,  under  Mr.  Arnott,  Oct.  4th,  1841.  This 


202  Progress  of  the  Medical  Sciences,  [July 

man,  who  had  but  one  eye,  the  left  having  been  destroyed  by  an  attack  of  severe 
inflammation,  and  rendered  atrophic  many  years  ago,  received  a  blow  on  it  last 
right  from  a  man's  fist,  at  the  door  of  a  poblichonse,  and  was  immediately 
deprived  of  sight.  The  globe  is  very  red,  not  from  inflammation,  but  from  blood 
extravasated  under  the  conjunctiva,  and  into  the  anterior  chamber.  In  the 
former  situation  it  is  principally  under  that  part  of  the  membrane  which  covers 
the  upper  half  of  the  eye;  in  the  latter  the  pupil  is  covered  and  a  great  part  of 
the  iris,  yet  this  membrane  at  its  lower  part  can  be  seen.  The  conjunctiva  is 
entire;  he  cannot  distinguish  light  from  darkness;  there  is  a  trifling  bruise  of  the 
lower  eyelid;  has  little  pain  in  the  eye,  and  no  headache;  smells  of  gin,  under 
the  influence  of  which  he  is  still.  To  have  twenty-five  grains  of  compound 
jalap  powder  directly,  and  the  lead  lotion  to  the  eye.  Confinement  to  bed  and 
low  diet. 

Mh.  No  pain;  bowels  acted  tolerably.  To  have  a  compound  senna  draught. 
Continue  lotion. 

1th.  So  much  absorption  of  the  blood  effused  under  the  conjunctiva  has  taken 
place,  that  a  rent  in  the  sclerotic  coat,  at  its  upper  part,  can  be  perceived,  about 
a  quarter  of  an  inch  in  length,  and  running  parallel  to  the  edge  of  the  cornea,  at 
the  distance  of  l-16th  of  an  inch.  The  pupil  also  can  be  recognised,  but  not  of 
its  natural  size,  form,  or  situation.  It  is  very  large,  oval,  and  close  to  the  mar- 
gin of  the  cornea,  at  the  upper  part,  that  which  corresponds  to  the  injury  of  the 
sclerotic.  The  iris  is  observed  to  be  tremulous.  The  globe  to  the  touch  is  soft 
and  flaccid. 

llth.  Absorption  further  advanced.  Rent  in  sclerotic  gapes  as  if  something 
slightly  protruded  through  it.  It  is  now  distinguished  that  one  side  of  the  oval 
pupil  is  formed  by  the  circular  edge  of  the  cornea,  the  iris  having  disappeared  at 
this  part;  sees  a  large  body  of  light.  To  have  five  grains  of  blue  pill  night  and 
morning.     Continue  the  lotion. 

IQth.  Blood  in  anterior  chamber  entirely  removed,  that  under  conjunctiva 
nearly  so;  rent  in  the  sclerotic  less  gaping,  more  light  seen;  can  distinguish  the 
form  and  outline  of  persons. 

21s^  Sight  improving;  can  see  the  hand,  and  tell  the  number  of  fingers  ex- 
tended; edges  of  the  crack  in  the  sclerotic  now  approximated,  so  that  it  now 
shows  as  a  mere  line;  globe  less  flaccid;  it  has  more  fulness  and  firmness;  iris 
still  tremulous;  gums  very  tender,  with  mercurial  fcetor  of  the  breath.  Omit  the 
pills. 

2bth.  Can  now  see  to  the  end  of  the  ward. 

Nov.  \st.     He  says  that  his  sight  is  weak.     To  have  a  blister  to  the  forehead. 
^ih.  His  sight  is  now  as  good  as  it  was  before  the  accident;  the   cicatrix  of 
the  rent  in  the  sclerotic  is  barely  distinguishable. 

Oct.  2Sth.  In  some  clinical  remarks  on  this  case  to-day,  Mr.  Arnott  observed 
that  the  eyeball  was  well  protected  by  its  deep  situation,  and  was  seldom  injured 
by  a  blow  of  the  fist,  as  our  pugilistic  encounters  sufficiently  attested,  although 
such  an  injury  might  occasionally  happen. 

In  the  condition  in  which  the  man's  eye  and  sight  were  on  his  admission,  he 
(Mr.  Arnott)  had  stated  at  the  time  that  caution  was  required  as  to  what  should 
be  said  of  the  chance  of  the  recovery  of  sight;  for  its  loss  might  depend  either 
on  the  blocking  up  of  the  pupil  by  the  extravasated  blood,  or  it  might  be  con- 
nected with  laceration  or  bruise  of  the  deeper  parts  of  the  eye,  especially  the 
retina. 

With  the  view  of  assisting  him  in  determining  on  which  of  the  two  causes 
just  mentioned  the  loss  of  sight  depended,  he  endeavoured  to  ascertain  from  the 
man  whether  any  interval,  however  brief,  intervened  between  the  receipt  of  the 
blow  and  the  total  loss  of  vision,  but  he  could  not  get  a  satisfactory  answer. 
The  man  was,  in  fact,  muddled  at  the  time  of  the  accident:  he  asserted,  how- 
ever, that  he  was  instantly  deprived  of  sight.  Had  he  (Mr.  Arnott)  been  able 
to  make  out  that  there  was  an  interval,  he  should  have  thought  more  favourably 
of  the  case;  but  when,  three  days  after  his  admission,  he  found  that  the  sclerotic 


1842.]  Ophthalmology.  203 

was  actually  burst  and  the  pupil  displaced,  that  the  eye  was  flaccid  and  the  iris 
tremulous,  he  expressed  himself  as  having-  little  expectation  of  the  sight  being 
restored.  The  displacement  of  the  pupil,  as  observed  in  this  case,  was  not  an 
unusual  effect  of  blows  on  the  eye.  It  seemed  to  depend  on  an  injury  done  to 
the  ciliary  ligament,  or  nerves,  the  iris  at  the  part  corresponding  to  the  blow  or 
injury,  contracting  and  disappearing.  On  the  other  hand,  from  a  blow  the  iris 
sometimes  became  separated  or  detached  from  the  ciliary  ligament,  and  then  a 
double  pupil  was  formed. 

The  treatment  of  the  case  was  sufficiently  simple;  there  was  effusion  of  blood 
within  the  eye,  but  no  sign  of  inflammation.  The  removal  of  blood  was  to  be 
the  work  of  nature;  we  could  do  little  to  help  her,  except  by  preventing  inflam- 
mation, which  would  have  interfered  with  the  process,  but  of  which  there  were 
no  signs  in  this  case.  The  patient  w^as  not  bled,  not  even  by  having  leeches 
applied.  He  was  not  of  full  habit,  and  had  an  indifferent  pulse.  He  was 
purged,  and  kept  on  low  diet,  and  cold  was  applied  to  the  eye:  these  remedies 
were  found  sufficient. 

Notwithstanding  the  unpromising  appearance,  the  case  turned  out  better  than 
was  anticipated.  Seven  days  after  his  admission,  he  could  distinguish  light 
from  darkness,  and  his  sight  gradually  improved  in  proportion,  apparently,  to 
the  removal  of  the  blood  from  the  interior  of  the  eye.  He  took  mercury  with  the 
view  of  aiding  absorption,  but  the  lecturer  questioned  if  it  had  much  to  do  with 
the  improvement. 

One  day  after  the  pupil  became  visible,  the  patient  hearing  him  advert  to  the 
situation  of  it  at  the  upper  part  of  the  eye,  informed  him  that  it  had  been  so  for 
the  last  four  years.  That  at  that  time  being  in  India,  he  had  received  a  blow 
from  a  man;  and  that  the  nail  of  his  thumb  wounded  his  eye,  and  that  the  sur- 
geon who  attended  him  then  told  him  of  the  alteration  in  the  pupil.  There  is 
no  reason  to  doubt  the  man's  statement,  though  possibly,  with  regard  to  the  in- 
jury by  the  nail,  there  might  be  some  question,  as  he  only  mentioned  this  after 
hearing  how  the  patient  in  the  next  bed  had  been  injured.  Since  the  accident 
in  India  his  sight  had  not  been  so  good  as  previously,  yet  up  to  the  occurrence  for 
which  he  entered  the  hospital,  he  was  able  to  follow  the  calling  of  a  newsman, 
and  could  read  with  the  aid  of  glasses.  He  had  now  nearly  recovered  the  same 
power  of  vision,  and  would  leave  the  hospital  next  week. 

62.  Symblepharon. — M.  Petrequin,  of  Lyons,  has  performed  a  somewhat 
novel  operation  for  the  cure  of  this  species  of  deformity,  the  result  apparently, 
in  the  case  recorded,  of  repeated  operations  for  pterygium.  A  gentleman  of 
Clermont,  Savoy,  was  affected  with  pterygia  in  each  eye,,  caused  by  chronic  en- 
gorgement. In  1834,  Mayor,  of  Geneva,  operated  on  him,  and  the  left  eye  was 
perfectly  cured;  the  pterygium  in  the  right,  on  the  contrary,  returned  at  the  end 
of  a  month,  and  was  attended  with  pain  and  some  difficulty  in  the  motions  of 
the  eye.  The  second  time  he  was  operated  on  by  M.  Maunoir,  but  with  tempo- 
rary success.  The  pterygium  returned,  and  increased  rapidly.  Riberi,  of 
Turin,  who  was  next  consulted,  excised  a  portion  of  the  caruncle  with  the  ptery- 
gium, and  applied  caustic  afterwards.  This  time  fibrous  bands  formed,  causing 
adhesion  of  the  eyelids  to  the  globe  of  the  eye.  These  bands  were  excised  by 
a  physician  at  Chambery,  the  operation  being  followed  by  large  granulations, 
which  were  extirpated  again  and  again,  and  finally  repressed  by  the  application 
of  the  sulphate  of  copper  and  nitrate  of  silver.  Cicatrization  took  place  gra- 
dually, but  at  the  same  time  there  formed  a  mass  of  fibrous  bands,  disposed  fan- 
shape,  the  base  attached  to  the  internal  surface  of  the  two  eyelids,  the  apex  ex- 
tending to  and  terminating  on  the  cornea,  which  it  partially  covered  to  the  extent 
of  two  lines  (l-6th  of  an  inch.)  M.  Petrequin  saw  the  patient  in  this  state  on 
the  10th  of  April,  1841,  and  on  examination  found  the  eyelids  bound  together 
and  to  the  eye,  by  a  multitude  of  dense,  fibrous  bands,  which  rendered  their 
molion  very  difficult.  When  the  patient  looked  outwards  to  the  right  he  had 
double  vision,  as  also,  but  in  a  less  degree,  when  he  looked  much  to  the  left. 


204  Progress  of  the  Medical  Sciences.  [Ju^y 

Cold,  exposure  to  the  air,  readingr,  and  writing  were  painful  and  fatiguing.     He 
could  not  turn  the  eye  outwards. 

This  case  was  not  unattended  with  difficulty,  in  consequence  of  the  great  ten- 
dency to  relapse  and  to  an  increase  of  the  disease.  Excision,  incision,  and  the 
application  of  caustic,  had  already  failed;  a  new  operation  was  therefore  requi- 
site, which  was  performed  in  the  following  manner  on  the  13th: — A  small  curved 
needle,  armed  with  a  double  thread,  was  passed  between  four  or  five  of  the  fibrous 
bands  of  the  lower  eyfelid  and  the  globe  of  the  eye,  and  the  threads  tied,  the 
inner  ligature  being  tied  somewhat  loosely.  The  operation  was  repeated  the 
next  day,  the  ligatures  being  placed  external  to  those  already  applied.  The  eye 
was  kept  immovable,  and  bathed  with  cold  water  and  laudanum.  On  the  15th 
the  adhesions  of  the  corneal  side  were  broken;  the  part  was  touched  with  caus- 
tic alum,  and  a  little  charpie  passed  behind.  The  sulphate  of  copper  was  applied 
lightly  the  four  following  days;  the  other  ligatures  separated  later;  the  lower 
eyelid  was  set  at  liberty,  and  became  free  and  mobile,  and  a  cure  was  effected. 
A  similar  operation  was  afterwards  performed  on  the  bands  of  the  upper  eyelid, 
but  the  results  were  not  so  successful.  It  was  followed  by  a  high  degree  of 
inflammation,  requiring  the  application  of  leeches,  mustard  pediluvia,  purga- 
tives, &c.  and  when  the  patient  left  Lyons  the  eyelid  was  only  partially  freed, 
but  its  motions  were  more  easy.  M.  Petrequin  heard  from  him  six  months  after- 
wards, and  he  was  doing  well.  A  few  months  later  he  was  informed  indirectly 
that  the  improvement  the  patient  had  experienced  had  not  continued  entirely.  A 
second  case,  of  an  equally  interesting  nature,  is  recorded  by  M.  Petrequin,  in 
which  the  adhesion  of  the  eyelids  to  the  eye  had  been  caused  by  the  application 
of  quick-lime.  The  patient  was  a  young  blacksmith,  and  had  "been  operated  on 
seven  times  unsuccessfully  previously  to  his  placing  himself  under  the  care  of 
M.  Petrequin.  The  adhesion  affected  the  lower  eyelid  chiefly  at  the  external 
canthus,  but  the  commissure  was  also  engaged;  the  motions  of  the  eye  were 
difficult  and  painful,  and  there  was  present  a  degree  of  strabismus  convergens, 
with  diplopia,  imperfect  vision,  &c.  The  ligatures  were  applied  four  or  five 
times,  each  successive  application  being  followed  by  apparent  improvement. 
The  first  was  applied  on  the  11th  of  July,  and  when  the  patient  left  the  hospital 
on  the  30th  the  adhesions  were  entirely  destroyed,  and  vision  perfect,  but  cica- 
trization was  not  quite  completed.  The  patient  was  to  return  in  September,  if 
any  contraction  or  difficulty  of  motion  appeared  afterwards,  and,  as  he  had  not 
done  so,  M.  Petrequin  concludes  him  cured. 

The  object  of  M.  Petrequin  in  applying  a  double  ligature  to  these  bands,  tying 
one  tightly,  and  the  other  more  loosely,  was,  that  the  separation  of  the  threads 
should  take  place  at  different  times,  so  that  the  wound  caused  by  the  ligature 
tightly  applied  might  be  healed,  or  nearly  so,  before  that  to  be  produced  by  the 
more  loose  one,  should  be  actually  open,  thus  inducing  cicatrization  of  each 
separately,  and  thereby  preventing  their  reunion.  The  portion  of  the  fibrous 
band  between  the  two  ligatures  could  not  form  adhesions  to  either  wound,  inas- 
much as  it  was  in  a  state  of  strangulation,  and  must  necessarily  fall  atrophied. 
The  more  dense  and  fibrous  the  bands,  the  more  easy  is  it  to  cause  a  difference 
of  several  days  between  the  separation  of  the  respective  ligatures,  attention 
being  paid  to  their  being  tied  in  different  degrees  of  constriction.  If  the  bands 
are  very  thick,  the  ligatures  must  be  applied  again  and  again,  the  needle  being 
passed  each  time  deeper  and  deeper.  After  the  operation,  it  is  requisite  to  keep 
the  eye  perfectly  motionless  and  closed,  to  prevent  those  motions,  which  might 
cause  traction  on  the  eye,  and  separate  the  ligatures  sooner  than  was  intended. 
— Prov.  Med.  and  Surg.  Juurn.  May  7,  1842,  from  Gaz.  Med.  de  Paris. 

[Of  the  safety  of  this  operation  of  M.  Petrequin  it  will  require  farther  expe- 
rience to  convince  us.  We  have  seen  a  case  somewhat  similar  to  that  first 
related,  and  induced  by  the  same  cause,  ill  judged,  repeated  operations  for  the 
removal  of  pterygium.  The  operations  of  some  modern  surgeons  on  the  eye  can 
scarcely  be  exceeded  in  rudeness.] 


1842.]  Ophthalmology.  205 

63.  Turpentine  in  Scrofulous  Corneiiis. — Mr.  Obre  relates  in  the  Lancet,  Ap. 
30,  1842,  two  cases  of  scrofulous  corneitis  successfully  treated  by  turpentine. 
He  gave  the  medicine  in  doses  of  from  half  a  drachm  to  a  drachm  three  times 
a  day. 

64.  Irideremia. — Mr.  France  has  published  a  case  of  absence  of  the  iris  in 
both  eyes,  in  the  person  of  a  young  woman,  an  oui-palient  at  the  eye  infirmary 
at  Guy's.  She  is  unable  to  bear  exposure  to  a  strong-  light;  sunshine  in  particu- 
lar is  disagreeable  to  her,  and  causes  profuse  lachrymation.  Objects  are  only 
distinctly  seen  when  within  the  distance  of  a  foot  or  two.  The  eyelids  are 
habitually  more  than  half  closed;  the  globe  of  each  eye  affected  with  an  almost 
incessant  oscillatory  motion  in  a  horizontal  direction,  and  the  power  of  directing 
the  eye  towards  an  object,  particularly  upwards  or  downwards,  is  much  im- 
paired. The  cornese  are  partially  clouded.  "The  sclerotic  coats  are  mode- 
rately healthy — perhaps  rather  more  bluish  than  natural;  their  degree  of  tension 
is  that  of  health.  On  inspecting  the  right  eye  very  carefully,  and  looking  above 
or  beside  the  corneal  nebula,  there  is  observed  a  central  opacity  of  the  anterior 
capsule  of  the  crystalline,  about  the  size  of  a  large  pin's  head;  and  a  similar 
spot  is  also  to  be  seen  on  the  posterior  capsule,  the  lens  remaining  perfectly 
transparent.  Thus  a  very  satisfactory  illustration  is  afforded  of  the  size  of  the 
space  between  the  cornea  and  capsule;  and,  again,  between  the  front  and  back 
walls  of  the  cavity  within  which  the  lens  is  contained.  In  the  left  eye,  the 
centre  of  the  anterior  capsule,  or  more  superficial  parts  of  the  lens,  is  opaque; 
while  the  posterior,  appearing  as  if  corrugated,  is  opaque  also  in  the  centre,  to 
about  one-third  of  its  extent,  and  shoots  forwards,  as  it  were,  flakes  of  opacity 
into  the  lens  on  the  nasal  side. 

*'  Witli  these  exceptions,  the  entire  space  viewed  through  either  cornea  is  of 
uniform  brownish  black  hue.  The  closest  examination  does  not  disclose  any 
vestige  of  iris." 

Of  this  singular  malformation,  Lawrence  has  seen  two  examples  in  children, 
Middlemore  one.  Von  Ammon,  of  Dresden,  has  depicted  several.  He  says, 
in  describing  them,  that  the  sclerotic  coats  have  been  invariably  found  free  from 
bluish  tinge,  and  decidedly  white — that  the  condition  of  the  lids  is  always,  or 
generally,  that  noticed  above — that  cataract  always  sooner  or  later  occurs,  and 
should  not  be  interfered  with,  and  that  sometimes  this  malformation  has  dis- 
played the  strongest  disposition  to  hereditary  transmission.  Oscillation  of  the 
globe  also  seems  to  be  very  frequent.— -Gt^^/'s  Hospital  Eeporis^  April,  1842. 

65.  Imperfect  development  of  the  Eyes  with  Cataract — The  following  very  in- 
teresting and  rare  case  of  imperfect  development  of  the  visual  organs  is  related 
by  Mr.  Walker,  of  Manchester,  in  our  esteemed  contemporary,  the  Provincial 
Medical  and  Surgical  Journal,  (Jan.  15th,  1842.)  Mary  Wild,  aged  one  month, 
admitted  an  out-patient,  July  20,  1841.  The  external  aspect,  when  the  eyelids 
are  closed,  is  that  of  great  depression,  such  as  is  seen  after  the  evacuation  of  the 
humours,  the  palpebrae  being  flattened  instead  of  possessing  the  convex  appear- 
ance observed  in  the  normal  state.  On  separating  the  lids,  the  eyes  have  the 
same  sunken  and  flat  appearance,  resembling  those  of  a  small  bird,  being  evident- 
ly imperfectly  developed;  the  corneai  are  transparent,  but  not  more  than  half  the 
usual  dimensions;  the  irides  of  a  dark  blue,  and  a  greyish  white  body — evidently 
the  opaque  lens — is  seen  within  the  pupils,  which  latter  are  of  the  ordinary  size. 

No  other  morbid  appearance  is  observable.  There  has,  however,  been  a 
slight  mucous  discharge  from  the  conjunctival  surface  of  both  eyes,  almost  ever 
since  the  period  of  birth,  but  this  is  inconsiderable.  The  child  occasionally 
opens  both  eyes,  and  appears  to  fix  them  on  the  window  as  if  sensible  of  the 
presence  of  light.     In  other  respects  she  is  in  good  health. 

The  usual  local  and  general  remedies  were  ordered,  with  a  view  to  the  cor- 
rection of  the   morbid  secretion  from  the  conjunctival  surface. 

July  23cZ.  The  mucous  discharge  much  abated.  Ordered  extract  of  belladonna 
to  be  rubbed  around  the  eyes  every  night. 

No.  VIL— July,  1842.  18 


206  Progress  of  the  Medical  Sciences,  [July 

27th.  The  pupils  are  considerably  dilated,  and  the  lenses  are  seen  to  be  per- 
fectly opaque. 

Jan.  ith,  1842.  The  child  has  been  occasionally  broncrht  to  the  hospital  since 
the  last  report,  but  no  change  is  perceptible  in  the  appearance  of  the  eyes.  The 
mother  is  unable  to  satisfy  herself  as  to  whether  the  child  exhibits  any  real  sen- 
sibility to  light.  She  often  places  a  lighted  candle  before  the  eyes,  but  thinks 
that  no  notice  is  taken  of  il.  The  child  is  now  very  delicate  in  appearance,  and 
its  health  not  very  good.  Whether  the  retina  is  sensible  or  otherwise  is  difficult 
to  decide.  Should  the  health  improve,  and  some  evidence  of  the  sensibility  of 
the  retina  become  apparent,  it  will  perhaps  be  desirable  to  operate  for  the  re- 
moval of  the  cataracts.  This  is  a  very  interesting  and  extremely  rare  case  of 
malformation,  or  rather  of  imperfect  development  of  the  visual  organs. 

66.  Cases  in  which,  after  the  failure  of  the  operation  for  Cataract  on  one  eye,, 
the  vision  of  both  eyes  was  restored,  tjy  operating  on  the  cataract  on  the  op' 
posite  side. — M.  Serre,  Prof,  of  Clinical  Surgery  at  Montpellier,  relates  three 
cases,  in  which,  after  the  lapse  of  months  (in  one  case  three  years)  from  the  un- 
successful operation  for  cataract  upon  one  side,  the  sight  of  both  eyes  was  re- 
stored by  operating  on  the  other  cataract.  The  conditions  common  to  all  these 
cases  were,  a  momentary  recovery  of  sight  immediately  after  the  first  operation, 
a  free  state  of  the  pupil  with  no  obstacle  to  the  arrival  of  the  rays  of  light  at  the 
retina,  and,  to  all  appearance,  only  a  partial  extinction  of  the  sensibility  of  that 
membrane.  Under  these  circumstances,  it  would  seem  that  the  sudden  stimulus 
of  the  light  admitted  into  the  eye  newly  operated  on,  is  sufficient  to  call  into 
sympathetic  action  the  dormant  nervous  energy  of  the  retina  on  the  opposite 
side.  And  if  more  observations  of  the  same  nature  should  present  themselves, 
it  may  come  to  be  a  question  whether,  in  certain  cases  of  amaurosis,  particularly 
in  the  asthenic  form,  light  may  not  be  advantageously  used  as  a  stimulant  to  the 
eye  by  means  of  glasses  adapted  to  that  purpose.  Again,  instead  of  declining 
to  operate  for  cataract  so  long  as  vision  remains  in  one  eye,  though  in  an  im- 
perfect degree,  may  we  not  attempt  the  operation  under  certain  circumstances, 
with  the  very  object  of  restoring  vision  to  that  eye]  Lastly,  in  opposition  to 
the  ideas  of  some  ophthalmologists,  may  not  the  excitement  produced  by  the 
operation,  or  by  the  contact  of  light,  contribute  to  restore  vision,  in  some  cases 
of  cataract  complicated  with  incipient  amaurosis'? — Land,  and  Edin,  Monthly 
Journ.  Med  Set..,  May  1842,  from  Gaz.  Med.  de  Paris. 

67.  Melanosis  of  the  Eye. — The  following  case  of  this  disease,  operated  on  by 
Dr.  Byron,  Surgeon  to  the  Navan  Infirmary,  was  communicated  to  the  Surgical 
Society  of  Ireland. 

"  Richard  Donnelly,  a  labourer,  aged  21  years,  was  admitted  into  the  Meath 
Infirmary  on  the  24th  March,  1827.  Hair  and  complexion  dark,  his  left  eye 
was  affected  with  cataract,  and  with  what  appeared  to  be  amaurosis  ;  the  con- 
junctiva was  extensively  chemosed,  and  the  eyeball  somewhat  enlarged;  the 
inflammation  and  lachrymation  inconsiderable.  He  complained  of  headache, 
his  pulse  was  60  and  full,  his  general  health  was  good,  and  his  constitution 
robust;  he  had  had  no  vision  in  the  eye  for  a  year;  the  other  symptoms  were 
only  of  a  week's  standing,  and  had  been  produced  by  striking  the  eye  against 
a  stick.  Three  weeks  afterwards  it  was  deemed  expedient  to  perform  the  opera- 
tion for  staphyloma;  as  the  functions  of  the  eye  were  irretrievably  gone,  it  was 
hoped  the  eye  would,  after  the  discharge  of  the  humours,  and  in  consequence  of 
the  enlarged  vessels  being  unloaded,  probably  sink  into  the  socket,  and  give  no 
further  trouble.  The  operation  was  accordingly  performed  on  the  27ih  March, 
somewhat  more  than  three  weeks  from  the  time  of  his  admission.  The  sclerotic 
and  choroid  coats  being  divided  three  lines  behind  the  ciliary  ligament,  and  a 
large  segment  made  of  the  ball,  which  included  within  it  the  lens  in  an  opaque 
state,  with  its  capsule  and  the  iris;  the  vessels  in  general  bled  freely,  and  some 
coagulated  blood  found  its  way  into  the  anterior  cells  of  the  vitreous  humour. 
He  had  an  anodyne  at  bedtime,  but  nolw^ilhstanding,  suffered  severe  pain  in  the 


1842.]  Ophthalmology,  207 

eye  and  slept  none.  An  emollient  poultice  and  water  dressing  were  applied. 
The  wound  discharged  pus  and  bloody  matter  in  moderate  quantity,  and  for 
some  days  the  swelling  appeared  to  be  gradually  diminishing;  however,  on  the 
29th  April,  about  a  month  after  the  operation,  the  report  was,  that  the  wound 
had  filled  up  and  the  eye  was  as  large  as  before  the  operation,  having  an  uniform 
fungous  aspect.  At  this  time  he  suffered  little  uneasiness  and  wished  to  go 
home — he  was  therefore  discharged. 

"  On  the  2d  February,  nine  months  afterwards,  he  again  presented  himself; 
the  tumour  had  very  considerably  increased  in  size  within  the  preceding  three 
months,  and  was  then  as  large  as  a  middle  sized  orange.  Its  circumference  at 
the  base,  including  the  lids,  measured  nine  inches,  in  the  centre  seven  inches 
and  a  half,  and  at  the  top  six  inches;  the  upper  eyelid  was  extended  for  two 
inches  over  it,  and  the  under  eyelid  for  one  inch;  and  they  both  adhered  to  its 
surface  through  the  medium  of  the  conjunctiva,  which  was  moveable  upon  it. 
The  anterior  surface  of  the  tumour  had  lost  its  smooth  uniform  condition,  and 
now  presented  an  irregular  aspect  from  the  existence  of  three  protuberances 
upon  it,  each  about  the  size  of  a  walnut.  The  most  prominent,  and  at  the  same 
time,  the  most  internal  of  these,  was  of  a  dark  purple  colour,  and  bled  when 
touched;  the  others  had  a  somewhat  less  vivid  tinge,  intermixed  with  a  light 
pink  shade;  and  the  base  of  the  tumour  partook  of  the  same  colour.  To  the 
touch  it  was  firm,  elastic  especially  in  the  situation  of  the  projections,  and  in 
some  places  hard.  The  patient  stated  that  it  had  sometimes  discharged  so  much 
as  a  pint. of  blood  at  once;  his  general  health  was  somewhat  impaired.  A 
fortnight  after  this  report,  on  the  16th  February,  he  was  re-admitled  into  the 
infirmary.  At  that  time  the  disease  was  evidently  advancing  with  rapidity.  The 
central  and  external  protuberances  had  increased,  and  presented  in  addition  to 
their  former  colours,  a  greenish  aspect;  their  surface  also  was  partially  ulcerated; 
three  ulcers  appeared  upon  them,  and  one  upon  the  lid  itself,  near  the  eyebrow. 
All  the  ulcers  discharged  a  small  quantity  of  ichor,  and  the  tendency  to  hemor- 
rhage appeared  in  a  great  measure  to  have  ceased — he  now  for  the  first  time, 
complained  occasionally  of  severe  pain  in  the  tumour  shooting  to  the  back  of  his 
head;  and  there  was  a  slight  degree  of  chronic  inflammation  of  the  upper  eyelid. 
His  pulse  was  80,  and  moderate,  and  his  general  health,  though  somewhat  im- 
paired, had  not  suffered  materially. 

"  The  operation  of  extirpation  of  the  globe  was  performed  on  the  28th  Feb- 
ruary, one  year  from  the  time  of  his  first  presenting  himself  at  the  infirmary,  and 
two  years  from  the  original  commencement  of  the  disease  in  the  eyeball. 

"  Operation. — An  incision  was  first  made  from  the  external  comniissiire  of  the 
eyelid,  to  the  external  angle  of  the  orbit;  this  from  the  elongated  state  of  the 
lids  was  fully  an  inch  and  a  half  in  length.  An  incision  was  next  carried 
through  the  conjunctiva  covering  the  tumour,  from  the  inner  angle  of  the  eye 
along  the  hairy  margin  of  the  under  eyelid  to  the  outer  angle,  where  it  joined  the 
first  incision.  A  similar  division  of  the  conjunctiva  was  made  above  along  the 
border  of  the  upper  eyelid  which  also  joined  the  first  incision  at  the  outer  angle 
of  the  orbit. 

"The  conjunctiva  and  lids  were  now  stripped  from  the  tumour  above  and  below, 
until  its  surface  was  completely  exposed  all  round,  as  far  as  the  margins  of  the 
orbit.  The  tendon  of  the  superior  oblique  muscle  was  next  divided  on  the  left 
forefinger,  and  subsequently  that  of  the  inferior  oblique  muscle  in  the  same 
manner.  The  division  of  these  tendons  allowed  the  fingers  to  be  passed  freely 
round  the  orbit  in  all  directions.  The  remaining  attachments  of  the  tumour, 
which  were  extensive,  were  afterv.^ards  divided,  and  the  diseased  mass,  which 
was  of  great  size,  its  posterior  half  filling  up  the  orbital  cavity,  was  removed. 

"The  OS  planum  was  perforated  for  a  space  as  large  as  the  nail  of  the  fore- 
finger, and  the  edges  of  this  perforation  were  rough.  There  was  a  smart  hemor- 
rhage from  the  ophthalmic  and  infra-orbital  arteries;  this  was  stopped  by  com- 
pression with  lint  and  the  fingers  during  the  time  that  some  portions  of  thickened 
fat  and  cellular  substance  were  being  removed.  The  orbit  was  then  filled  with 
lint  and  the  bleeding  quickly  ceased.     A  portion  of  the  upper  eyelid  including 


208  Progress  of  the  Medical  Sciences.  [July 

the  ulcer  was  excised.  The  patient  lost  about  eight  ounces  of  blood.  He  sus- 
tained the  operation  courag-eously. 

"  Examination  of  the  tumour. — The  report  taken  at  the  time  stated  it  to  be  a 
diseased  structure  ^  sui  generis,''  resembling  neither  cancer  nor  fungus  hasma- 
todes.  I  have  now  no  hesitation  in  pronouncing  it  to  have  been  a  good  example 
of  melanosis — the  report  goes  on  to  state  that  there  was  no  appearance  what- 
ever of  the  lachrymal  gland,  and  scarcely  a  vestige  of  the  healthy  eye;  in  place 
of  the  eyeball  was  a  fleshy  firm  mass,  on  the  surface  of  which  ran  the  straight 
and  oblique  muscles,  increased  in  size,  particularly  the  obliquus  inferior,  abduc- 
tor, and  adductor.  Beneath  these  was  a  strong  tendinous  fascia,  or  fibrous 
membrane,  apparently  the  sclerotic  coat  extended  and  altered  in  its  nature,  on 
stripping  off  which  the  surface  of  the  tumour  was  exposed;  the  entire  superficies 
was  rendered  irregular  by  numerous  projections  or  tubercles  of  various  sizes, 
from  the  dimensions  of  a  pea  to  that  of  a  chestnut,  the  larger  being  of  a  dark- 
brown  or  blackish  colour,  the  smaller  of  a  light-brown  hue.  Between  these 
tubercles  was  interposed  a  white  demicartilaginous  substance;  the  larger  projec- 
tions on  being  divided  exuded  a  matter  similar  to  the  pigmentum  nigrum  of  the 
choroid  coat,  and  were  composed  of  a  more  dense  structure  of  the  same  nature; 
the  centre  of  the  tumour,  for  an  extent  equal  to  at  least  one  third  of  the  entire 
mass,  was  occupied  by  a  similar  substance.  The  smaller  tubercles  on  being 
cut  into  presented  an  aspect  of  the  same  sort,  but  lighter  in  colour;  som«  of  them 
were  firm  to  the  touch,  others  soft;  the  largest  ones  were  generally  softest. 
The  optic  nerve  was  sound,  but  narrowed  near  its  junction  with  the  eye.  As 
to  the  termination  of  the  case,  he  progressed  favourably  to  a  satisfactory  cure. 
He  was  treated  like  other  patients  who  have  undergone  operations  of  magnitude 
— his  fever  was  moderate— his  pulse  never  rising  above  80 — for  some  days  he 
complained  of  a  slight  headache,  which  did  not,  however,  interrupt  sleep,  and  he 
was  somewhat  annoyed  by  a  swelling  of  the  eyelids  and  left  side  of  the  face. 

"  On  the  tenth  day  these  symptoms  had  disappeared;  the  entire  cavity  looked 
healthy  and  was  granulating  rapidly:  the  denuded  bone  was  covered  and  the 
eyelids  had  regained  their  natural  size,  the  upper  lid  appearing  at  this  time  to 
be  scarcely  of  sufficient  size  to  allow  of  its  covering  the  exposed  socket.  The 
edges  of  the  wound  in  the  upper  eyelid  had  approximated. 

"On  the  twentieth  day  half  the  cavity  had  been  filled  up — on  the  sixtieth  day 
there  was  no  longer  a  cavity  in  the  place  of  the  eyeball,  and  the  lids  adhered  to 
the  granulations  proceeding  from  the  socket,  and  thus  covered  the  socket  so  as 
to  diminish  deformity.  On  the  eighty-eighth  day  the  wound  was  completely 
healed,  and  the  appearance  of  the  parts  good.  There  was  a  slight  natural  se- 
cretion from  some  small  portions  of  conjunctiva  which  had  remained  adherent  to 
the  tarsal  cartilages.  He  was  discharged  cured,  and  continued  well,  and 
perfectly  free  from  any  return  of  his  complaint,  as  I  had  an  opportunity  of 
ascertaining  for  nearly  four  years  afterwards,  when  he  was  carried  off  by  3.  fever. 

"Mr.  Houston  said  the  details  of  some  other  cases  of  melanosis  were  given 
by  Dr.  Byron  in  the  paper  which  he  held  in  his  hand,  but  as  he  understood 
from  Mr.  Adams  that  they  would  be  shortly  published,  he  would  not  take  up 
the  time  of  the  meeting  by  reading  them.  He  wished  to  add  that  a  preparation 
was  preserved  in  the  Museum  of  the  College,  of  a  case  similar  to  that"  under 
consideration;  the  morbid  specimen  had  been  presented  by  Mr.  Palmer,  and  the 
account  of  the  case  will  be  found  in  the  catalogue  of  the  Museum;  this  patient 
lived  for  seven  years  after  the  operation,  and,  on  examination  after  death, 
unequivocal  signs  of  the  disorder  were  found  in  several  of  the  internal  organs. 

"  Mr.  Adams  said,  the  case  just  read  appears  to  me  a  very  interesting  example 
of  malignant  disease  of  the  structures  of  the  globe  of  the  eye  combined  with 
melanotic  deposits,  and  we  derive  some  little  encouragement  from  the  relation 
of  such  facts  to  undertake  the  very  severe  operation  of  extirpation  of  the  eye. 
There  were  three  cases,  as  far  as  the  affection  of  the  organs  contained  in  the 
orbit  was  concerned,  in  the  Richmond  Hospital,  which  were  somewhat  similar 
to  that  related  by  Dr.  Byron,  but  were  not  so  fortunate  in  their  termination.  In 
one  of  these  cases  the  operation  of  extirpation  was  performed,  and  the  result  was 


1842.]  Ophthalmology.  209 

unfavourable;  in  the  other  two  we  had  to  congratulate  ourselves  that  no  opera- 
tion had  been  resorted  to,  as  the  post-mortem  examination  showed  extensive 
malignant  disease  of  the  liver,  with  melanotic  deposits  in  other  organs.  The 
preparations,  showing  the  morhid  alterations  of  structure,  have  been  preserved 
by  our  learned  curator,  Mr.  Smith.  One  of  these  cases,  Levy,  was  under  the 
care  of  the  late  Dr.  M'Dowell;  the  other  was  a  patient  of  our  learned  Vice-Pre- 
sident, Dr.  O'Beirne.  He  will  be  able  to  furnish  you  with  more  accurate  par- 
ticulars relating  to  it  than  I  can.  The  third  case  was  under  the  care  of  Dr. 
M'Dowell.  With  respect  to  the  first  case,  that  of  Levy,  astat.  67,  he  had  the 
disease  of  the  eye  for  six  years,  and  the  operation  of  extirpation  was  performed; 
some  months  afterwards  he  died  with  symptoms  of  disease  of  the  brain,  but  no 
post-mortem  examination  was  permitted.  The  interior  of  the  globe  of  the  eye 
was  filled  with  melanotic  matter,  mixed  with  portions  of  a  firm,  white,  scirrhoid. 
structure;  the  morbid  mass  was  still  enclosed  in  the  sclerotic  coat.  Dr. 
O'Beirne's  case,  Larrify,  was  a  man  of  60  years  of  age.  He  had  disease  of  the 
eyeball,  which  was  much  enlarged,  and  the  man  had  been  blind  for  many  years 
— he  died  hectical.  Upon  dissection  it  was  found  that  the  structures  contained 
in  the  orbit  had  undergone  complete  disorganization,  the  result  of  malignant 
disease.  A  vertical  section  of  the  tumour  is  preserved  in  the  Museum  of  the 
Richmond  Hospital,  and  this  section  exhibits  a  mixture  of  the  matter  of  mela- 
nosis, with  the  white  fibrous  tissue  of  scirrhus,  producing,  as  Mr.  Smith  re- 
marked, an  appearance  not  unlike  certain  kinds  of  marble.  The  tumour  was  of 
considerable  size,  being,  in  its  vertical  diameter,  about  three  inches;  and  in  its 
antero-posterior  four  inches;  it  had  projected  far  in  front  of  the  orbit,  and  had 
penetrated  the  optic  foramen;  the  remains  of  the  cornea  and  sclerotic  were  found 
in  the  most  inferior  part  of  the  tumour.  The  circumstance  in  this  case,  most 
worthy  of  the  attention  of  the  practical  operating  surgeon  is — that,  coinciding 
with  this  malignant  disease  of  the  eyeball,  the  liver  was  affected  with  a  mixture 
of  melanosis,  and  the  tubercle  circumscripta,  or  white  tubercle  of  Dr.  Farre. 
The  spigellian  lobe  was  perfectly  black  from  infiltration,  with  melanotic  matter 
surrounded  with  a  cyst.  This  lobe  was  increased  eight  or  ten  times  its  normal 
size — it  was  in  fact  the  size  of  a  small  melon;  throughout  the  remainder  of  the 
liver  were  many  tubercles,  some  while,  others  black,  and  there  were  others 
again,  presenting  both  colours.  A  careful  examination  of  the  brain  discovered 
no  lesion  there;  but  the  optic  nerve  was  implicated  in  the  disease  as  far  back  as 
the  optic  foramen,  which  was  much  larger  than  this  aperture  normally  is.  He 
believed  the  valuable  communication  brought  before  the  Society  last  winter  by 
his  friend,  Mr.  Smith,  would  be  in  the  recollection  of  the  members,  in  which 
Doctor  M'Dowell's  case  of  melanosis  of  the  eye,  combined  with  extensive 
melanotic  deposits  in  the  internal  organs,  was  detailed  and  commented  upon. 
The  preparations  are  preserved  in  the  Museum  of  the  Richmond  Hospital,  and 
are  well  worth  examination.  Mr.  Adams  said  before  he  sat  down  he  wished 
to  mention  that  Dr.  Young,  Surgeon  to  the  Monaghan  Infirmary,  had  given  him 
some  of  the  details  of  a  case  of  melanosis  of  the  eye,  in  which  he  had  performed 
the  operation  of  extirpation  of  the  eye,  and,  as  Dr.  Young  was  present,  he  was 
sure  he  would  have  much  pleasure  in  communicating  the  particulars  to  the 
Society. 

*'  Dr.  Young  said  he  regretted  he  had  not  the  notes  of  the  case  (to  which  Mr. 
Adams  had  alluded)  by  him;  as  far  as  his  recollection  served  him  the  patient 
was  a  man  aged  about  50,  but  looking  older,  who  applied  to  him,  with  a  small 
livid  tumour,  about  the  size  of  a  pea,  growing  from  the  conjunctiva;  it  was  easily 
removed  with  a  scissors;  the  patient  returned  in  some  months  with  a  second 
tumour;  it  was  not,  however,  seated  in  the  cicatrix,  but  on  the  opposite  side  of 
the  cornea,  and  this  he  also  removed.  In  about  five  months  the  patient  again 
returned;  he  now  complained  of  violent  pain  in  the  head;  the  eyeball  was 
enlarged,  had  a  tuberculated  appearance,  and  protruded  from  the  socket;  the 
pain  was  intolerable;  I  told  him  that  his  only  chance  of  relief  was  in  the  extir- 
pation of  the  eye,  to  which  he  refused  to  consent;  he  went  away,  and,  after 
some  time,  again  returned,  and  begged  of  me  to  perform  the  operation,  which, 

18* 


210'  Progress  of  the  Medical  Sciences,  [Ju^y 

after  some  time,  I  did;  the  orbit  filled  up,  and  the  wound  healed,  as  in  the  case 
described  by  Doctor  Byron.  Some  months  subsequently,  however,  a  tumour 
formed  in  the  site  of  the  parotid  gland,  and  the  patient  died. 

"Dr.  Jacob  said  he  had  brought  with  him  a  drawing  taken  a  number  of  years 
ago,  which  he  exhibited  to  the  meeting.  The  patient  was  a  woman  between  60 
and  70  years  of  age;  there  was  a  growth  of  rounded  granular  masses  projecting 
beyond  the  lids,  which  was  so  much  like  malignant  structure  that  he  recom- 
mended its  removal.  There  was  little  blackness  superficially,  but  it  became 
quite  evident  when  a  section  was  made  of  the  tumour,  he  has  no  doubt  that  it 
was  a  case  of  melanosis  of  the  eye:  12  months  afterwards  he  saw  the  patient 
well.  He  had  a  case  lately  of  melanosis  in  a  young  man  which  was  in  the 
form  of  a  single  black  dot,  about  the  size  of  a  pea,  situated  upon  the  lid,  which 
commenced  as  a  small  vascular  tumour:  he  removed  it,  including  a  large  piece, 
by  means  of  a  V  incision:  the  wound  did  not  heal  by  the  first  intention,  but 
cicatrization  was  effected  with  very  little  deformity.  There  has  been  no  return 
of  the  disease  in  this  case. 

"  Mr.  Adams— As  melanosis  of  the  eye  is  not  much  spoken  of  by  English 
authors,  at  least  the  ordinary  works  on  diseases  of  the  eye  do  not  give  many 
authentic  cases  of  this  disease,  I  may  therefore  mention,  that  last  summer  I  had 
nnder  my  care  in  the  Richmond  Hospital,  a  man  aged  68,  Garret  Doyle,  affected 
with  melanosis  of  the  lower  eyelid  of  the  right  eye;  it  had  originated  in  a  small 
tumour  about  the  size  of  a  black  currant  in  the  lower  eyelid,  and  had  remained 
stationary  for  some  years;  it  then  began  to  increase,  and  upon  its  sides  and  all 
round,  similar  tumours  appeared,  so  that  when  the  man  was  admitted  into  the 
Richmond  Hospital,  it  had  attained  the  size  of  a  small  orange;  it  was  dark 
coloured,  and  lobulated  throughout,  and  bled  whenever  it  was  touched;  its  pedi- 
cle was  very  small  and  therefore  it  was  readily  excised;  much  of  the  eyelid  was 
however  of  necessity  removed  with  it,  the  hemorrhage  was  easily  restrained, 
and  the  wound  speedily  healed — the  man  left  the  hospital,  and  we  have  not 
since  heard  of  him — a  section  was  made  of  the  black  lobulated  mass  which  was 
removed.  Mr.  Adams  said,  that  the  first  drawing  he  held  in  his  hand  gave  an 
excellent  idea  of  the  external  appearance  of  the  tumour,  and  the  expression  of 
countenance  of  the  patient;  the  second  drawing  showed  the  structure  of  the  entire 
of  the  morbid  mass,  the  colour  of  the  tumour  externally  was  black,  but  on  a  sec- 
tion of  it,  exhibited  a  white  interior.  The  reverse  was  the  case  in  the  melanotic 
tumour,  presented  this  evening  by  Dr.  Jacob,  for,  in  his  case  the  tumour  was 
only  black  in  the  interior. 

"Mr.  Rumley  said  he  regretted  Mr.  Palmer  was  not  present;  however,  he  had 
a  perfect  recollection  of  the  case  to  which  Mr.  Houston  had  alluded — several 
surgeons  had  refused  to  remove  the  diseased  eye,  Mr.  Palmer  performed  the 
operation,  and  it  was  so  successful,  that  the  patient  lived  seven  years  after- 
wards. On  examination  after  death,  there  were  evident  signs  of  the  disease  in 
several  of  the  internal  organs. 

"  Dr.  O'Beirne  said,  although  the  hour  for  adjourning  had  arrived,  he  could 
not  resist  stating  some  of  the  particulars  of  a  case  which  he  has  no  doubt  was 
one  of  melanosis,  and  which  occurred  so  far  back  as  the  year  1818.  The  patient, 
a  gamekeeper  in  the  employment  of  the  Earl  of  Granard,  was  completely  blind 
of  the  right  eye;  on  examination  he  found  a  granular  tumour  exactly  covering 
the  cornea  of  a  perfectly  black  colour,  and  in  shape  and  size  resembling  a  small 
blackberry;  it  was  moveable,  and  could  be  raised  from  the  cornea  by  means  of 
a  forceps.  He  lifted  it  with  a  hook,  and  then  dissected  it  carefully  off:  imme- 
diately afterwards  the  patient  said  he  had  some  vision  in  the  eye:  the  cornea  was 
delicately  flocculent,  but  cleared  perfectly  under  the  application  of  a  solution  of 
nitrate  of  silver,  and  in  a  fortnight  the  patient  was  able  to  return  to  his  employ- 
ment, and  to  shoot  with  his  usual  accuracy.  This  man  was  alive  three  years 
afterwards,  but  he  had  not  heard  further  of  him — at  that  time  the  disease  was 
but  carelessly  observed,  and  not  named.  He  (the  President)  sent  the  tumour 
as  a  curious  one  to  Sir  P.  Crampton,  who  will  probably  recollect  it  and  the  ac- 
count given  of  it." — Dub,  Med.  Press,  April  20,  1842. 


I 


1842.]  Midwifery,  211 

68.  Cysticerus  lodged  under  the  Conjunctiva. — Dr.  Hcering,  of  Luisburg,  re- 
lates a  case  in  which  a  cysticerus  cellulosus  of  the  size  of  a  pea,  existed  under 
the  conjunctiva  at  the  external  angle  of  the  eye.  The  patient,  a  girl  of  seven 
years,  had  hurt  the  eye  against  the  edge  of  a  tub.  Dr.  H.  thinks  that  the  de- 
velopment of  the  hydatid  is  to  be  ascribed  to  this  hurt. — Journ.  des  Com.  Med. 
Churg.,  Dec.  1841. 

69.  Cataract  suddenly  formed  in  both  Eyes. — Dr.  Martin  of  Portlaw  commu- 
nicated to  the  Surgical  Society  of  Ireland,  (April  16th,  1842,)  the  following 
example  of  this  very  rare  occurrence. 

"  Mary  Grant,  aged  35,  of  a  miserable  cachectic  habit,  after  sitting  up  for  seve- 
ral nights  with  her  invalid  mother,  suffering  much  bodily  and  mental  distress, 
and  crying  a  great  deal,  fell  asleep  in  the  sitting  posture,  by  the  fire-side,  at 
about  twelve  o'clock,  on  the  night  of  Friday,  October  15,  1841.  About  four  or- 
five  o'clock  she  awoke,  and  (although  her  vision  was  before  perfect)  she  then 
found  herself  unable  to  distinguish  any  object  around  her,  and  when  the  clearer 
light  of  day  came,  she  was  but  able  to  trace  the  outline  of  the  window  sash.  Hav- 
ing applied  to  me  for  advice,  three  days  after,  I  was  surprised  on  examination 
to  find  the  lens  of  both  eyes  semiopaque,  and  presenting  the  appearance  of  being 
starred  from  the  centre,  as  if  breaking  up  during  maceration.  She  complained 
of  severe  pains  in  the  forehead,  jaws,  and  shoulders — pulse  80,  full  and  hard — 
tongue  loaded  with  white  fur — bowels  confined.  By  means  of  blue  pill,  bitters, 
and  blisters  to  the  temples,  the  pains  were  removed,  and  her  general  health  im- 
proved, but  the  lenses  gradually  became  more  opaque,  and  she  is  now  unable 
to  trace  outlines  of  objects  passed  before  her  eyes,  although  the  retina  is  per- 
fectly sensible  to  the  impression  of  light.  That  she  had  perfect  vision  up  to  the 
night  on  which  she  states  she  became  blind,  1  feel  perfectly  satisfied,  as  on  that 
evening  having  been  in  attendance,  I  saw  her  moving  about,  and  nurse-tending 
her  mother,  and  I  had  seen  her  frequently  during  the  previous  month." 

Dr.  Martin  also  stated  that  he  remembered,  when  a  pupil,  to  have  seen  a  some- 
what analogous  case.  The  man  was  a  patient  in  Sir  P.  Dunn's  Hospital,  and 
the  following  was  the  history  which  he  gave:  he  said  that  he  had  beem  married 
to  a  farmer's  daughter,  and  after  the  usual  fun  of  an  Irish  wedding,  he  retired 
to  bed,  his  sight  being  perfectly  good.  Very  early  in  the  morning  he  was  called 
by  the  necessities  of  nature  to  the  outside  of  the  house,  when  he  became  con- 
scious of  the  loss  of  sight.  Fearing  the  ridicule  of  his  friends  he  made  his  way 
into  the  house  to  where  his  clothes  lay,  which  he  found  with  some  difficulty, 
and  left  his  bride  to  wonder  at  his  loss  for  the  next  two  months.  He  came  up 
to  Dublin,  and  was  admitted  into  Sir  P.  Dunn's  Hospital,  where  he  was  suc- 
cessfully operated  on  by  Dr.  Jacob.  I  need  not  add  that  his  story  was  laughed 
at  and  disbelieved  at  the  time;  but  I  have  little  doubt  now,  that  it  was  analo- 
gous to  that  of  Mary  Grant.  In  his  case  also,  as  in  that  of  Mary  Grant,  the 
blindness  was  not  complete  at  once;  in  the  end,  however,  both  lenses  became 
densely  opaque. — Lublin  Med.  Press,  May  4,  1842. 


MIDWIFERY. 

70.  Extra-uterine  Pregnancy. — A  woman,  70  years  of  age,  was  admitted  into 
the  Hospital  Cochin,  under  the  care  of  M.  Blache,  for  an  abdominal  tumour, 
which  she  had  had  for  thirty  years.  The  tumour,  which  occupied  the  left  iliac 
fossa,  was  large  and  hard;  it  had  latterly  become  very  painful;  the  abdomen  was 
tense,  and  painful  to  the  touch;  and  the  lower  extremities  oedematous.  She  died 
of  peritonitis  in  September  last.  On  examination  of  the  body,  the  tumour  was 
found  to  consist  of  the  remains  of  a  full-grown  foetus,  almost  all  the  bones  being 
connected  together  by  incomplete  ligaments,  and  forming  a  complete  skeleton 
twisted  on  itself.  The  pelvis  and  lower  extremities  were  the  back  part  of  the 
tumour,  the  occiput  in  front.  The  head  constituted  at  least  two-thirds  of  the 
whole  mass.   This  poor  woman  considered  that  this  tumour  showed  itself  when 


21^  Progress  of  the  Medical  Sciences,  [Juty 

she  was  forty  years  old;  she  ceased  to  menstruate  at  fifty,  having  previously 
borne  one  child  at  the  age  of  seven-and-twenty. — Frov.  Med.  and  Surg.  Journ., 
May  28ih,  1842. 

71.  Number  of  Pulsations  of  the  Fvetal  Chord. — Mr.  Streeter  stated  that  he  has 
recently  met  with  a  case  of  prolapsus  of  the  funis,  at  that  stage  of  labour  when 
the  OS  uteri  was  scarcely  larger  than  a  shilling;  he  took  the  oportunity  of  verify- 
ing the  number  of  pulsations  of  the  fostal  chord,  and  of  ascertaining  whether  Dr. 
Hamilton's  statement  respecting  the  slow  pulse  of  the  foetus  was  correct;  he 
found  the  mother's  pulse  to  be  under  100,  whilst  that  of  the  foetus  was  120. 
The  chord  was  coiled;  he  drew  it  down,  but  it  retracted;  this  he  repeated  several 
times,  and  always  with  a  similar  result.  He  endeavoured  to  return  it  within  the 
OS  uteri,  but  was  unable  to  do  so.  The  dilatation  of  the  os  uteri  progressed 
slowly,  the  pulsation  in  the  chord  ceased,  and  the  child  was  born  dead. 

72.  Rupture  of  the  Womb  during  Gestation — Recovery. — Dr.  Richter  relates 
an  example  of  this  occuring  in  a  Moravian  peasant,  20  years  of  age,  who,  while 
crossing  a  bridge  in  April  1840,  when  in  the  ninth  month  of  pregnancy,  was  sud- 
denly seized  with  a  fainting  fit,  which  lasted  a  considerable  time.  Upon  recover- 
ing from  it,  she  complained  of  great  pain  in  the  lower  part  of  the  abdomen,  with 
violent  motion  of  the  infant.  This  latter  continued  for  twenty-four  hours,  and  the 
former,  with  more  or  less  intensity,  for  four  weeks.  The  fever  then  subsided, 
and  she  was  enabled  to  rise.  On  the  18th  of  June,  a  quantity  of  very  fetid  pus 
escaped  from  the  vagina,  the  uterus  and  abdomen  seemed  to  diminish  in  size, 
and  the  motions  of  the  child  ceased  completely.  In  the  beginning  of  July,  the 
integuments  round  the  umbilicus  became  inflamed,  and  ulceration  took  place, 
giving  vent  to  a  greenish  yellow  fluid,  similar  to  that  which  was  passed  from 
the  vagina.  Some  days  subsequent  to  this,  the  patient  felt  a  hard  body  in  the 
vagina,  which  she  extracted,  and  which  was  found  to  be  a  bone,  about  two 
inches  long,  and  about  the  size  of  a  crow  quill.  On  the  15th  of  July,  Dr. 
Ritcher  was  consulted.  She  had  then  all  the  symptoms  of  hectic  fever;  the 
abdomen  was  painful  on  pressure,  and  on  the  left  of  the  umbilicus,  which  was 
ulcerated  to  about  a  quarter  of  an  inch,  was  felt  a  round  hard  tumour.  A  bone 
was  discovered  firmly  wedged  in  the  mouth  of  the  uterus;  tepid  water  injected 
into  the  vagina  escaped  by  the  opening  in  the  abdomen.  Several  bones  of  the 
extremities  of  a  foetus  were  extracted,  and  frequent  injections  of  warm  water 
were  had  recourse  to.  The  patient's  general  health  became  much  improved. 
Towards  the  end  of  August  another  fistula  took  place  below  the  umbilicus,  into 
which  it  soon  opened.  A  slough  having  separated  from  this,  a  hard  body  was 
felt,  which,  upon  being  removed,  was  seen  to  be  the  scapula.  The  remains  of 
the  foetus  were  then  taken  away  by  degrees.  The  intestinal  canal  had  been  per- 
forated by  the  ulcerative  process,  as  fecal  matter  escaped  both  from  the  fistulous 
opening  and  from  the  vagina.  On  the  13th  of  October  the  discharge  had  ceased. 
She  gained  strength  rapidly,  and  was  soon  able  to  follow  her  domestic  employ- 
ments.— Lond.  and  Edin.  Monthly  Journ.  Med.  Sci.,  Feb.  1842,  from  Gaz.  Med. 
de  Paris,  Oct.  2,  1841. 

73.  On  the  Management  of  the  Placenta. — Mr.  Joseph  Bell  relates,  in  the 
London  Medical  Gazette  (Jan.  14th,  1842),  a  number  of  cases  to  prove  the  efficacy 
of  a  mode  of  managing  the  placenta,  recently  recommended  by  Mr.  Murphy. 
It  is  chiefly  applicable  to  cases  where  it  is  usually  thought  necessary  to  intro- 
duce the  hand  for  the  purpose  of  extracting  the  placenta,  and  consists  in  the  ap- 
plication of  a  broad  bandage  round  the  abdomen,  and  firm  pressure  made  with 
both  hands  on  the  fundus  uteri.  The  same  practice  he  has  also  found  of  use 
previous  to  delivery,  in  cases  of  inefficient  pains.  Mr.  Bell  seems  strongly  op- 
posed to  the  practice  of  introducing  the  hand  into  the  uterus  to  extract  the  pla- 
centa, under  any  circumstances,  and  while  he  admits  that  there  are  cases  of  re- 
tained placenta,  in  which  the  above  measures  are  attended  with  very  little 
benefit,  recommends  that  in  them  the  child  should  at  once  be  put  to  the  nipple 
as  a  preferable  course  to  the  usual  practice.     This,  he  says,  has  always  been 


1842.]  Midwifery,  213 

followed  by  uterine  contraction,  cessation  of  the  flooding-,  and  expulsion  of  the 
secundines. — Land,  and  Edin.  Monthly  Journ.  Med.  Set.,  May,  1842. 

74.  Fads  relative  to  the  statistics  of  Menstruation, — The  following  results  have 
been  obtained  by  different  observers. 

Petrequin,  from  272  cases  noticed  in  France,  gives  the  period  of  its  appearance 
as  follows: 

In  4  at  10  years  of  age  In  27  at  18  years  of  age 

10  at  11  12  at  19 

15  at  12  7  at  20 

33  at  13  5  at  21 

33  at  14  1  at  22 

45  at  15  

48  at  16  272 

32  at  17 
Hence,  the  period  at  which  it  generally  occurs  in  France,  is  between  13  and 
15  years  of  age. 

He  also  fixes  the  period  of  cessation  at  between  the  35th  and  55th  years. 
From  a  comparison  of  60  cases,  it  appears  that  the  discharge  ceases  between 
35  and  40  years  of  age,  in  about  one  eighth;  between  40  and  45,  in  one  quarter; 
between  45  and  50,  in  one  half;  and  between  50  and  55,  in  one  eighth  of  the 
whole. — Medico-Chir.  Rev.  from  Bull.  Med.  Beige. 

Dr.  Adelmann  of  Fulda  in  Germany,  ascertained  the  period  at  which  men- 
struation had  commenced  in  507.  According  to  him,  the  average  age  in  girls 
with  black  hair  was  16;  in  those  with  brown,  it  was  17,  and  in  those  with  fair 
hair,  between  16  and  17.  The  average  duration  of  each  menstrual  period,  was 
four  or  five  days  for  the  black  haired,  and  four  for  each  of  the  others.  Only  one  in 
102  cases  was  met  with  who  menstruated  regularly  at  the  interval  of  three 
weeks:  all  the  rest  did  so  at  regular  periods  of  four  weeks. — Edinburgh  Med, 
and  Surg.  Journ.  from  Neue  Zeitschrift fur  Geburtskunde. 

The  researches  of  Brierre  de  Boismont  have  been  more  extensive  than  either 
of  the  foregoing. 

As  to  the  first  appearance,  of  276  women  living  in  the  country,  the  mean  age 
was  14  years  10  months;  of  205  living  in  towns,  14  years  9  months;  and  of 
359  either  born  in  Paris,  or  who  lived  there  at  least  a  year  prior  to  menstruat- 
ing, the  mean  age  was  as  follows;  in  171  poor  women,  14  years  10  months, 
which  agrees  with  Marc  d'Espine  and  Bouchaconrt's  statements;  in  135  of  the 
middling  classes,  14  years  and  5  months;  in  32  girls  in  M.  Bouvier's  Orthopce- 
dic  establishment,  14  years  8  months,  and  in  53  of  the  highest  ranks,  13  years 
7  months.  Chomel,  Andral  and  Recamier,  likewise  fix  the  age  for  commencing 
menstruation,  among  the  upper  classes,  at  between  12  and  14.  The  average 
age  obtained  by  the  union  of  359  of  all  classes,  in  the  capital,  is  14  years  6 
months.  Marc  D'Espine  places  the  mean  figure  in  Paris  at  14.965.  It  is  at 
Manchester,  15.191,  and  at  Marseilles  and  Toulon  14.015.  Of  652  women,  63 
have  never  menstruated  regularly.  The  period  of  return  is  generally  28  days, 
but  in  a  great  number  examined,  30  days  were  found  to  intervene.  The  dura- 
tion appears  to  be  very  irregular.  Of  562  women,  it  continued: 
In  172,     8  days  In  21,     6  days 

119,     3  days  12,     7  days 

78,     4  days  17,     about  9  days 

62,     2  days  

46,     5  days  562 

35,     1  day 
The  menses  continued  longest  in  the  inhabitants  of  the  city,  and  the  nervous 
and  indolent. — Medico-Chir.  Rev.   April  1842,  from  the  Memoirs  dc  rAcademie 
Roy  ale  de  Medecine.  T.  R.  B. 

75.  Extraordinary  Birth. — Dr.  Schnackenberg  relates  in  the  Neue  Zeitschrift 
fur  die  Geburtskunde,  a  case  in  which  a  dead  child  was  born,  the  head,  right 


214  Progress  of  the  Medical  Sciences.  [July 

foot,  left  hand,  and  umbilical  cord,  all  presenting  at  once.  The  right  parietal 
bone  of  the  head  was  applied  against  the  piibes  of  the  mother;  the  left  was 
turned  backwards,  with  the  sole  of  the  right  foot  resting  on  it;  this  latter  being 
covered  by  the  left  hand,  the  back  of  which  lay  against  the  hollow  of  the 
sacrum.  When  arrived  at  the  vulva,  the  left  hand  was  protruded  before  the 
head;  the  body  of  the  foetus,  after  its  birth,  preserved  the  same  position  as  it  had 
in  the  womb. — Prov.  Med.  and  Surg.  Journ.^  May  14th,  1842. 

7G.  Msfradion  of  the  Uterus  after  delivery. — In  our  No.  for  August  1839,  will 
be  found  an  account  of  two  cases  in  which  the  uterus  was  dragged  away  by 
ignorant  mid  wives,  and  two  other  examples  of  the  same  horrid  transaction  are 
there  alluded  to,  and  we  have  now  to  add  to  this  catalogue  of  atrocities,  a  fifth 
example,  related  by  Dr.  Peracchi  in  the  Annali  Univ.  di  Medicina.  The  sub- 
ject of  this  last  case,  Rosa  Gazzola,  38  years  old,  was  attended  in  her  fifih  con- 
finement, in  1837,  by  a  soi-disant  sage  femme.  She  was  well  delivered,  but  after 
the  expulsion  of  the  placenta,  she  suffered  from  intense  uterine  pains,  and  a  feel- 
ing of  weight  in  the  vagina.  The  midwife  examined  her,  and  stated  that  these 
pains  were  caused  by  the  presence  of  another  child  in  the  uterus.  In  pursuance 
of  this  opinion,  she  introduced  her  hand  into  the  vagina,  said  she  felt  the  child, 
seized  it,  and  made  great  and  forcible  traction.  The  patient  felt  that  she  was 
being  lacerated;  four  strong  men  were  holding  her,  while  the  midwife  continued 
her  efforts  at  traction.  At  last,  after  unheard-of  efforts,  the  pretended  child  was 
dragged  out  of  the  vagina,  and  the  midwife  remarked  that  the  nates  were  born, 
the  rest  of  the  body  was  behind.  In  order  to  aid  her  efforts,  she  wrapped  up 
the  protruded  portion  tightly  in  a  handkerchief,  and  continuing  to  pull,  she  finally 
tore  away  the  entire  uterus  from  the  body  of  the  unfortunate  mother. 

Dr.  Peracchi,  who  was  sent  for,  found  tremendous  hemorrhage,  and  the  pa- 
tient constantly  fainting.  She  appeared  like  a  corpse,  the  pulse  could  not  be 
felt,  a  large  quantity  of  the  bowel  protruded  through  the  vulva,  and  the  vagina 
was  full  of  coagula  of  blood.  The  doctor  was  much  alarmed  at  the  state  in 
which  he  found  the  unhappy  sufferer,  and  still  more  so  when  he  ascertained  the 
womb  had  been  torn  away.  He  returned  the  bowels,  raised  the  pelvis,  &c.,  and 
had  recourse  to  cordials;  the  patient  gradually  revived;  fever  set  in,  requiring 
bleeding,  &c.;  and  the  poor  woman  finally  recovered. 

At  the  period  when  the  catamenia  should  be  present,  Gazzola  su-ffers  from 
general  prostration,  oppression,  vomitings,  headaches,  and  abdominal  pains.  Her 
hair  has  fallen,  the  face  is  pale,  the  muscles  thin  and,  as  it  were,  atrophied;  the 
voice  is  harsh  and  disagreeable;  speech  difficult.  The  vulva  is  natural,  the 
vagina  about  three  inches  long,  and  terminating  by  a  thin  yielding  cul-de-sac. 
At  the  antero-superior  part  of  the  canal  is  an  irregular,  hard,  and  painful  cica- 
trix, about  an  inch  and  a  half  long.  The  urine  and  fasces  pass  with  difficulty 
and  pain.  The  examination  of  the  organ  showed  it  was  completely  torn  away, 
together  with  the  Fallopian  tubes  and  broad  ligaments. 

The  midwife  was  proceeded  against  criminally,  and  sentenced  to  one  month's 
imprisonment  and  a  small  pecuniary  fine. 

77.  Polypus  of  the  Uterus  expelled  by  the  action  of  Secale  Cornutum. — M.  P. 
MoYLE  was  requested  to  attend  without  delay  a  Mrs.  W.,  who  had  suddenly 
lost  a  large  quantity  of  blood  from  the  womb,  and  had  just  recovered  from  a 
long  state  of  syncope.  The  blood  was  lost  in  about  two  or  three  minutes.  She 
had  frequently  had  small  hemorrhages  previously,  and  was  becoming  weaker  in 
consequence.  Her  legs  and  thighs  were  swollen  almost  to  bursting,  her  coun- 
tenance pallid,  respiration  difficult,  and  general  health  decaying.  After  she  had 
recovered  greatly  from  her  fainting,  and  after  Mr.  Moyle  had  satisfied  himself 
that  the  flooding  was  owing  to  polypus  of  the  uterus,  he  proceeded  as  follows: 

"A  fresh  appearance  of  hemorrhage  induced  me  to  give  her  at  once  two 
drachms  of  the  tincture  of  secale  cornutum,  the  valuable  effects  of  which  I  had 
often  before  experienced.  I  also  applied  a  bandage  firmly  round  the  abdomen, 
and  applied  cloths,  wetted  with  cold  vinegar  and  water,  to  the  pudendum.    The 


i 


1842.]  Midwifery.  215 

discharge  proved  to  be  little,  and  no  faintness  followed.  In  twenty  minutes 
after  the  first  dose,  the  tincture  was  repeated,  and  in  a  few  minutes  she  com- 
plained of  being-  griped.  Suspecting  this  griping  to  be  a  slight  contraction  of 
the  uterus,  I  ventured  an  examination  by  the  vagina.  The  vagina  was  full  of 
coagula;  the  os  uteri  was  flabby  and  dilated  to  the  size  of  half-a-crown  piece, 
immediately  within  which  I  found  a  substance  of  somewhat  firmer  texture  than 
the  coagula,  and  around  which  my  finger  passed  freely.  During  the  examina- 
tion there  was  a  pain  of  sufficient  force  of  the  os  uteri  to  embrace  the  finger 
firmly,  and  I  now  felt  confident  of  being  able  to  subdue  the  hemorrhage  for  the 
present,  and  was  not  without  hopes  that  I  might,  by  a  perseverance  of  the 
remedy,  enable  the  uterus  to  throw  off  the  extraneous  substance  within  it.  A 
third  dose  was  now  administered,  which  kept  up  the  pains  at  short  intervals, 
but  they  were  weak  and  feeble.  Finding  this  the  case,  the  supposition  was, 
that  she  was  too  much  reduced  from  the  disease  and  the  recent  loss  of  blood  for 
the  medicine  to  have  its  full  eflect.  A  cup  of  gruel,  with  a  small  quantity  of 
brandy  in  it,  was  given  her,  and  in  a  half  an  hour  after,  another  similar  potion, 
which  had  the  effect  of  reviving  her  to  a  great  degree.  I  now  took  my  leave 
about  eight  o'clock  P.  M.,  giving  directions  for  a  repetition  of  the  food,  together 
with  some  beef-tea,  at  intervals  of  an  hour  or  every  second  hour,  leaving  with 
her  four  doses  of  the  secale,  to  be  taken  at  intervals  of  half  an  hour;  in  case 
there  should  be  the  slightest  appearance  of  flooding,  I  was  to  be  sent  for  imme- 
diatey. 

"Early  on  the  following  morning,  I  found  her  labouring  under  sharp  contrac- 
tile pains  of  the  uterus,  from  having  taken,  two  hours  previously,  two  doses  of 
the  secale.  Examination  discovered  the  mass  of  polypus  filling  the  vagina. 
The  patient  was  very  cheerful,  and  expressed  herself  convinced  that  the  mass 
was  coming  away.  The  pains  were  by  this  time  not  so  severe  as  they  had 
been,  and  consequently,  I  now  gave  her  three  drachms  of  the  tincture  in  a  little 
brandy.  This  had  the  effect,  in  about  twenty  minutes,  of  producing  a  severe 
pain,  which  brought  the  mass  to  the  os  externum.  It  was  now  grasped  with 
the  hand,  and,  on  the  recurrence  of  the  pain,  the  whole  was  discharged.  Slight 
hemorrhage  only  followed  the  expulsion  of  the  polypus,  which  equalled  in  size 
two  large  placentae.  From  this  moment  she  recovered  with  great  rapidity. 
There  was  a  slight  appearance  of  the  menses  at  the  end  of  six  weeks,  succeeded 
by  a  more  abundant  appearance  at  the  termination  of  another  similar  period. 
She  daily  improved  in  health,  the  oedema  gradually  subsided,  and  although  she 
was  for  many  months  unable  to  put  the  whole  weight  of  her  body  on  her  right 
leg,  yet  from  bandaging,  the  use  of  tonics,  &c.,  she  is  now,  in  all  respects,  a 
perfectly  healthy  robust  woman." 

[The  successful  result  of  this  case  induced  Mr.  Moyle  to  try  the  use  of  the 
ergot  in  another  patient  who  had  previously  been  under  his  care.  He  visited 
her  on  the  7th  Sept.  1.839,  and  gave  her  four  doses  of  the  tincture  of  secale  cor- 
utum,  3ij.  in  each  dose.  Two  or  three  slight  pains  were  now  experienced, 
nausea  and  vomiting  followed.  Shortly  afterwards  she  had  a  severe  labour 
pain.  She  then  took  §iij.  more  of  the  tincture,  and  the  pains  increasing,  the 
polypus  mass  was  felt  at  the  os  uteri.  By  the  further  use  of  the  medicine,  the 
substance  was  completely  expelled.  It  was  about  the  size  of  an  average  pla- 
centa. 

'J'he  following  case  related  by  Dr.  Somerville  will  corroborate  the  statements 
of  Mr.  Moyle.] 

"  Mrs.  G.,  aged  26,  had  been  subject  to  femoral  hernia  of  both  sides  for  seve- 
ral years,  and  for  some  time  previous  to  her  marriage,  up  to  the  period  of  her 
first  confinement,  had  suffered  much  from  leucorrhoea.  At  the  time  of  her  de- 
livery, she  had  an  attack  of  uterine  hemorrhage,  which  subsequently  returned 
at  intervals,  and  continued  with  considerable  violence,  till  she  called  on  me  for 
advice,  about  fifteen  months  after  her  delivery.  I  did  not,  at  that  time,  propose 
an  examination,  but  prescribed  a  few  doses  of  ergot  in  powder.  The  next  day 
she  complained  of  being  severely  pained,  since  she  had  taken  the  powder;  and 
the  discharge  still  continuing,  I  examined  the  state  of  the  uterus,  and  found  a 


216  Progress  of  the  Medical  Sciences,  [J"^y 

mass  slightly  protruding  through  the  os  uteri,  which  I  believed  to  be  a  polypus. 
The  ergot  was  given  in  increased  quantity,  and  at  shorter  intervals,  which  pro- 
duced severe  bearing-down  pains,  and  in  a  short  time,  a  polypus  about  the  size 
of  a  large  orange,  having  a  thick  pedicle,  and  attached  to  the  anterior  surface  of 
the  cavity  of  the  uterus,  was  propelled  into  the  vagina.  After  an  interval  of  a 
few  days  to  permit  the  irritability  of  the  uterus  to  subside,  a  ligature  of  silver 
wire  was  applied  by  means  of  a  double  canula,  but  it  broke  on  being  tightened. 
Another  and  stronger  wire  was  applied,  and  after  it  had  been  firmly  tightened, 
great  pain  and  tenderness  of  the  tumour,  and  also  of  the  abdomen  supervened.  The 
abdominal  tenderness  was  speedily  relieved  by  antiphlogistic  means,  but  the 
pain  and  uneasiness  of  the  tumour  still  continued,  in  such  a  degree,  as  to  require 
great  gentleness  and  caution  in  tightening  the  ligature.  The  wire,  however, 
gradually  ulcerated  through  the  portion  to  which  it  was  applied.  On  its  sepa- 
ration, the  lower  half  of  the  pedicle  of  the  tumour  was  found  divided,  while  the 
upper  half,  which  probably  had  been  first  separated,  had  become  reunited,  and 
a  distinct  sulcus  was  felt  on  its  upper  surface,  where  the  reunion  had  taken 
place.  The  circumstance  of  the  time  required  for  tightening  the  ligature  being 
considerably  longer  than  usual,  on  account  of  the  tendency  to  abdominal  in*- 
fiammation  and  the  tenderness  of  the  mass  itself,  will  probably  account  for  this 
unusual  occurrence.  The  polypus  became  gradually  smaller,  and  the  pain  in  it 
having  abated,  another  ligature  was  applied  in  the  same  site,  which,  in  a  very 
few  days,  effected  a  complete  separation  of  the  tumour,  and  it  was  removed  by 
the  fingers.  On  inspecting  the  polypus,  the  sulcus,  where  the  second  ligature 
had  been  applied,  and  reunion  had  taken  place,  was  perceived  extending  all 
round  the  upper  half  of  the  pedicle.  The  uterus  was  examined  by  the  speculum 
shortly  after; — the  os  uteri  was  still  open,  and  its  lips  swollen  and  tender,  but 
these  symptoms  were  speedily  removed,  and  the  woman  is  now  in  the  enjoy- 
ment of  excellent  health. 

Dr.  M'Farlane,  in  his  Essay  on  Polypus  of  the  Uterus,  in  the  Glasgow  Medi- 
cal Journal  for  1828,  mentions  the  following  case,  where  the  effect  of  the  secale 
cornutum  was  equally  decided,  and  the  separation  of  the  tumour  was  effected 
without  the  use  of  any  other  means,  as  in  those  ef  Mr.  Moyle. 

A  lady,  who  had  been  subjected  to  profuse  hemorrhage  for  a  period  of  ten 
months,  had  for  several  years  been  affected  with  habitual  leucorrhcea.  After 
various  remedies  had  been  employed  without  effect,  an  examination  was  made, 
and  the  uterus  felt  enlarged.  Considering  that  the  continued  hemorrhage  might 
be  owing  to  the  presence  of  a  polypus,  or  some  other  tumour  within  the  uterine 
cavity,  Dr.  McFarlane  resolved  to  try  the  effect  of  the  ergot  of  rye,  as,  from  the 
character  of  the  lady,  and  the  history  of  the  case,  he  had  no  reason  to  suspect 
pregnancy.  After  the  administration  of  some  doses  of  this  medicine  in  infusion, 
severe  pains  were  produced,  which  continued  for  several  hours,  when,  on  exa- 
mination, a  polypus  was  found  in  the  vagina,  having  a  slight  pedicle,  which  in 
a  few  days  ulcerated,  and  was  easily  extracted. — Braithwaite's  Retrospect,  No. 
IV,  from  Lond,  and  Edin.  Monthly  Journ.  Med.  Sci.,  June  and  August,  1841. 

78,  Pregnancy  unattended  with  the  usual  signs,  and  in  tvhich  parturition  oc- 
curred without  labour-pains:  rupture  of  the  funis  which  remained  untied  forty- 
jive  minutes.  By  Thomas  Lewis,  Esq.,  Liverpool. — A  lady,  aged  31,  had  no- 
ticed an  enlargement  in  the  abdomen  for  six  or  seven  months.  She  felt  certain 
she  was  not  pregnant,  because  she  had  not  experienced  symptoms  similar  to 
those  of  her  first  pregnancy.  Catamenia  appeared  last  eight  or  nine  months  ago. 
External  examination  not  proving  satisfactory,  examination  per  vaginam  was 
made,  which  disclosed  the  nature  of  the  case.  The  os  uteri  was  dilated  to  the 
size  of  a  shilling,  the  neck  entirely  expanded,  and  the  membranes  and  child's 
head  could  be  felt.  Though  informed  she  was  pregnant  she  was  sceptical,  and 
made  no  preparation  for  the  event.  On  the  5th  of  January  the  author  was 
sent  for,  and  found  the  child  born  before  his  arrival.  The  funis  was  ruptured 
about  four  inches  from  the  umbilicus.  It  appears  the  lady  had  suffered  from 
diarrhoea  for  two  days  previous.    At  one  o'clock  in  the  morning  she  awoke  with, 


1842.]  MedicalJurisprudence  and  Toxicology.  217 

she  says,  griping  pains  in  the  belly.  These  continued  until  six  o'clock,  when 
she  got  out  of  bed  for  ease.  She  walked  into  an  adjoining  room,  and  bending 
herself  rested  her  hands  on  a  table.  Suddenly  the  waters  broke,  and  the  child 
was  expelled,  and  fell  on  the  floor.  She  states  positively  she  had  no  pains  in 
the  loins  nor  hearing-down  pains  previous  to  the  expulsion  of  the  child. — Lancet, 
May  21,  1842. 


P 


MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY. 

79.  Guerard  on  the  consequences  of  drinking  cold  liquids  when  heated. — The 
author  has  been  induced  to  examine  this  subject,  as  well  in  consequence  of  the 
frequency  and  fatality  of  accidents  from  the  above  cause,  as  from  the  suspicion 
of  poisoning  to  which  they  have  given  rise. 

Whilst  dangerous,  and  even  fatal  effects  from  drinking  cold  liquids,  when  the 
body  is  heated,  have  long  been  noticed,  the  nature  of  the  injury  induced  has 
remained  in  doubt.  M.  Guerard  refers  this  to  several  causes — injuries  of  in- 
nervation— affections  of  the  digestive  apparatus,  and  affections  of  the  circulat- 
ing system. 

The  nervous  symptoms  are  violent  local  pains,  trismus,  various  spasmodic 
phenomena  and  sudden  death.  Those  of  the  two  last  classes,  are  inflammations 
of  the  digestive  and  circulating  systems. 

In  illustration  of  the  first  cause  assigned,  Guerard  asserts,  that  every  species 
of  cold  liquid,  (wine  and  beer,  as  well  as  water,)  will  produce  these  dangerous 
eflTects,  if  taken  when  the  body  is  heated  by  exercise  or  violent  passion,  and  fur- 
ther that  it  is  not  the  coldest  liquids  that  will  cause  this,  but  those  having  the 
ordinary  temperature  of  cellars,  viz.,  about  53*^  of  Fahrenheit.  So  far  as  cases 
have  come  to  his  knowledge,  liquids  of  this  temperature  most  certainly  induce 
a  fatal  termination,  and  not  those  cooled  down  to  zero  or  below  it. 

If  this  be  correct,  we  are  not  warranted  in  ascribing  these  fatal  results  to  a 
purely  physical  cause.  The  heat  of  the  body,  even  when  highly  excited  by  a 
warm  temperature,  violent  exercise,  and  even  disease,  is  at  its  greatest  possible 
maximum  at  107°  (42°  centigrade)  and  a  glass  of  water  at  53°,  drunk  under 
these  circumstances,  causes  death.  But  on  the  other  hand,  if  the  body  be  not 
heated,  we  can  drink  water  cooled  down  to  32°  in  winter  and  even  spring,  with 
impunity,  although  the  animal  heat  be  98°.  A  difference  in  the  former  case  of 
only  54°,  whilst  in  the  latter,  it  is  66. 

This  diversity  is,  according  to  our  author,  to  be  explained  by  the  fact,  that  in 
the  former  case,  the  temperature  has  been  excited  beyond  its  natural  limit,  and  a 
corresponding  result  has  thus  been  induced  in  the  vital  properties,  and  more  par- 
ticularly, in  the  sensibility. 

Among  the  remarkable  cases,  mentioned  by  M.  Guerard,  explanatory  of  the 
second  cause,  is  that  of  a  bookbinder  in  Edinburgh.  This  person,  enjoying  ex- 
cellent health,  arose  at  six  in  the  morning,  to  light  his  fire,  and  then  drank  a 
large  tumbler  of  cold  water  from  a  pitcher.  He  returned  to  bed,  and  was  imme- 
diately seized  with  a  violent  pain  at  the  pit  of  his  stomach.  To  this,  after 
intense  sufferings,  succeeded  vomiting,  which  could  not  be  checked.  Death 
took  place  in  eleven  hours,  and  on  dissection,  no  appreciable  lesion  could  be  dis- 
covered. 

Here  are  conditions  analogous  to  those  noticed  under  the  first  head.  The  body 
■was  warm  from  the  heat  of  the  bed;  the  stomach  empty.  The  water  cooled 
down  to  the  temperature  of  the  room,  and  probably  near  zero,  and  drank  sud- 
denly. 

In  other  instances,  the  result  has  been  gangrene  or  dropsy.  A  Marechal  de  Loyis, 
carrying  a  despatch  in  great  haste  on  a  very  warm  day,  took  a  single  draught  from 
a  bottle  of  beer  that  stood  in  ice.  He  died  in  consequence  in  five  days,  and  the 
stomach  was  found  inflamed  and  gangrenous.  It  is  remarkable,  that  liquids  less 
cold  cause  death  instantaneously.  M.  Guerard  endeavours  to  explain  this  vari- 
No.  VII.— July,  1842.  19 


218  Progress  of  the  Medical  Sciences.  [July 

ance,  by  their  different  effects  on  the  nervous  extremities  distributed  over  the 
mucous  coat.  In  the  first  case,  the  ice  cold  liquids  paralyze  as  it  were  the  ner- 
vous filaments,  and  the  impression  received  by  them  is  not  communicated  to  the 
cerebro-spinal  centre.  In  the  last,  the  constriction  is  less  considerable,  and  the 
impression  on  the  nervous  organization  is  transmitted  to  the  whole  system. 
Thus,  the  disorder,  vi^hich,  in  the  former  case,  was  confined  to  the  stomach,  is 
now  by  the  action  induced,  a  general  one. 

As  to  the  third  division,  viz.  the  effects  on  the  circulating  system,  M.  Guerard 
adduces  several  instances  of  haemoptysis,  caused  by  drinking  cold  water,  when 
the  body  was  heated,  and  in  a  state  of  profuse  perspiration.  The  following  also 
illustrates  the  medical  jurisprudence  of  former  days.  The  dauphin,  son  of 
Francis  the  First,  whilst  heated  and  perspiring  from  playing  tennis,  drank ^a 
glass  of  cold  water.  He  died,  in  consequence,  of  pleurisy,  which  supervened. 
Soon  the  cry  of  poisoning  was  heard  throughout  France.  The  count  Montecu- 
culi,  cup-bearer  to  the  prince,  was  put  to  the  torture,  and  in  his  agonies  confessed 
that  he  had  added  arsenic  to  the  water.     He  was  drawn  asunder  by  four  horses. 

Pneumonia  is  a  frequent  consequence  of  imprudence  in  the  use  of  cold 
water. 

In  conclusion,  the  author  recapitulates  the  conditions  which  induce  these 
grave  accidents;  the  previous  heating  of  the  body;  an  empty  condition  of  the 
stomach;  the  great  quantity  of  drink  swallowed  at  a  draught;  and  lastly,  and 
of  less  importance  than  any  of  the  former,  the  temperature  of  the  fluid.  In  ad- 
dition to  the  facts  already  mentioned,  he  urges  the  circumstance  that  ice  never 
causes  such  fatal  terminations. 

The  emptiness  of  the  stomach  must  accelerate  the  result,  since  the  liquid 
comes  in  direct  contact  with  the  mucous  coat.  So  also,  if  a  large  quantity  be 
swallowed,  it  reaches  a  large  portion  of  the  surface.  Ice,  on  the  contrary,  as 
it  melts  slowly,  can  only  produce  a  limited  effect. — Bulletin  of  the  Royal  Jlca- 
demy  of  Medicine^  sitting  of  January  25,  1842.  T.  R.  B. 

80.  Detection  of  Arsenic  acid  hy  M.  Eisner. — (Translated  from  the  Annales 
Des  Mines,  by  Professor  Griscom.)  It  is  well  known  that  M.  Runger  disco- 
vers free  sulphuric  acid  by  covering  a  porcelain  desk  with  a  solution  of  one  part 
of  sugar  and  thirty  parts  of  water,  heating  the  dish  by  exposure  to  steam  till  it 
acquires  the  same  heat,  and  then  dropping  on  it  the  liquid  supposed  to  contain 
the  free  sulphuric  acid.  A  black  colour  indicates  the  presence  of  this  acid,  be- 
cause the  greater  number  of  other  free  acids  do  not  decompose  the  sugar  in 
this  manner. 

1  have  found  that  arsenic  acid  acts  in  a  peculiar  manner,  producing  on  the 
porcelain  coaled  with  sugar,  a  beautiful  scarlet  red  colour.  The  reaction  is  sen- 
sible with  a  liquid  containing  only  -,-^l^  of  arsenic.  The  action  of  arsenic  acid 
produces  on  the  sugar,  ulmic  acid,  which  brings  the  former  acid  to  an  inferior 
degree  of  oxydation. — Journal  of  the  Franklin  Institute,  February,  1842. 

T.  R.  B. 

81.  On  spots  in  glass  resembling  those  of  Marsh,  produced  by  a  reducing  fame. — 
Professor  Louyet,  at  a  previous  meeting,  stated  that  he  had  obtained  by  means  of 
acurrent  of  hydrogen  gas,  metallic  spots  in  certain  glass  vessels, greatly  resem- 
bling those  produced  by  the  apparatus  of  Marsh,  from  arsenic.  He  was,  how- 
ever, unable  to  explain  the  cause,  since  on  analysis  no  arsenic  could  be  detected 
in  the  glass.  By  subsequent  experiments,  he  was  satisfied  that  they  were  owing 
to  the  presence  of  lead  in  the  glass  itself,  and  he  ascertained  this  in  the  follow- 
ing manner.  Three  grammes  of  the  glass  powdered,  were  melted  with  four 
times  their  weight  of  carbonate  of  potash,  in  a  platina  crucible.  The  substance 
obtained  was  then  treated  with  boiling  diluted  nitric  acid  and  the  liquid  evapo- 
rated to  dryness.  This  was  again  dissolved  in  boiling  water,  and  filtered  anew, 
in  order  to  separate  a  portion  of  silica.  On  adding  an  excess  of  potash  in  solu- 
tion, a  gelatinous  precipitate  was  obtained,  which  was  collected  on  a  filter, 
washed  and  then  dissolved  in  nitric  acid.     Liquid  bichromate  of  potash  caused 


1842.]  Medical  Jurisprudence  and  Toxicology.  219 

a  yellow  precipitate  when  added  to  this  solution;  a  plate  of  zinc,  a  metallic 
crystallization,  and  sulphuret  of  ammonia,  a  black  precipitate. 

The  remainder  of  the  acid  solution  was  submitted  to  a  stream  of  sulphuretted 
hydrogen:  and  the  black  precipitate  thus  obtained,  after  beincr  washed,  and  pro- 
perly dried,  was  mixed  with  a  portion  of  black  flux  and  reduced.  A  metallic 
substance  was  the  result  which  proved  to  be  pure  lead. — Bulletin  of  Ike  Royal 
Academy  of  Sciences  of  Brussels,  vol.  8,  May,  1841.  T.  R.  B. 

82.  Do  Metallic  poisons  when  mixed  with  cultivated  land^  enter  into  the  compo- 
sition of  the  vegetables  produced? — We  mentioned  in  the  last  number,  that  this  had 
been  proposed  as  a  prize  question  by  the  Academy.  Five  memoirs  were  re- 
ceived in  reply,  three  of  which  came  too  late.  To  the  others,  the  Academy 
awarded  silver  medals. 

The  first  (written  by  M.  Louyet,  Professor  of  Chemistry  in  the  Central 
School  of  Commerce  and  Industry  at  Brussels)  stated  that  the  author  had  impreg'- 
nated  a  portion  of  soil  with  arsenic  in  three  different  proportions— also  a  part 
with  arsenite  of  potash — with  tartrate  of  potash  and  antimony — with  sulphate 
of  iron — sulphate  of  copper — sulphate  of  zinc — proto-nitrate  of  mercury — and 
corrosive  sublimate.  In  these,  barley,  rye,  and  buckwheat  were  sown.  When 
the  quantity  of  arsenic  in  a  square  of  64  feet  of  ground,  amounted  to  1280 
grains,  germination  was  checked,  but  when  the  quantity  in  the  same  space  was 
more  than  256  grains,  neither  it  nor  the  full  growth  of  the  plants  was  at  all  re- 
tarded. The  roots,  leaves,  and  seeds  of  the  cereals  thus  produced,  were  mace- 
rated in  a  gentle  heat  for  two  or  three  days  with  a  solution  of  caustic  potash. 
This  after  being  concentrated  and  neutralized  with  sulphuric  acid,  was  intro- 
duced into  the  apparatus  of  Marsh.  No  indication  of  arsenic  was  perceived. 
The  author  then  examined  a  portion  of  the  above  soil,  and  found  in  it,  a  sensible 
quantity  of  arsenious  acid  in  a  soluble  state.  It  would  thus  seem,  that  although, 
the  cereals  grow  in  a  soil  impregnated  with  arsenic,  yet  their  roots  do  not  im- 
bibe an  appreciable  portion  of  it.  Mr.  Martens,  the  reporter  on  this  memoir, 
however  regrets  that  the  author  did  not  employ  the  method  of  carbonization 
with  nitric  acid,  as  much  the  most  certain  for  detecting  minute  portions  of 
arsenic. 

When  the  grains,  which  had  been  checked  in  their  growth  by  the  too  strongly 
impregnated  soil,  were  submitted  to  analysis,  they  were  found  to  contain  a  sen- 
sible quantity  of  arsenious  acid,  thus  proving  that  the  absorption  of  the  poison 
had  checked  vegetation. 

No  poison  could  be  detected  in  plants  grown  on  the  soil  containing  arsenite 
of  potash,  but  the  author  ascertained  that  this  salt  was  almost  entirely  insoluble, 
having  been  mainly  converted  into  an  arsenite  of  lime. 

A  similar  result  was  obtained  with  plants  from  the  soil  containing  tartar  eme- 
tic.    This  salt  had  also  become  insoluble. 

Iron  in  notable  quantities  was  detected  in  every  part  of  the  plant,  grown  on 
the  soil  impregnated  with  sulphate  of  iron,  thus  apparently  proving  that  non- 
poisonous  substances  are  more  readily  absorbed  than  their  opposites.  So  also 
with  plants  grown  on  the  soil  containing  copper.  That  metal  was  detected  in 
the  leaves,  twigs  and  seeds,  while  on  the  contrary,  no  trace  of  it  could  be  disco- 
vered in  cereals  growing  on  soil  not  impregnated. 

In  plants  from  the  ground  containing  sulphate  of  zinc,  proto-nitrate  of  mercury 
and  corrosive  sublimate,  no  trace  of  these  substances  could  be  discovered,  nor 
did  they  appear  to  have  influenced  or  retarded  their  growth.  When,  however, 
.plants  were  watered  with  a  strong  solution  of  corrosive  sublimate,  they  died  in 
a  few  days,  and  on  analysis,  the  poison  was  detected. 

The  conclusion  of  the  author  from  these  experiments  is,  that  a  soil  containing 
a  notable  proportion  of  metallic  poison  will  not  check  or  impede  the  growth  and 
maturity  of  cereals. 

The  second  memoir  was  written  by  M.  Verver,  of  the  University  of  Gronin- 
gen.  He  also  had  divided  off  a  garden  plot  into  various  squares  and  impregnated 
the  earth  in  each  with  the  respective  poisons.     The  results  with  arsenic  were 


220  Progress  of  the  Medical  Sciences.  [July 

precisely  similar  to  those  of  Louyet.  He  did  not  detect  any  copper  in  the  vege- 
tables raised  from  that  soil,  but  this  is  ascribed  to  the  insufficiency  of  the  analy- 
sis, and  probably  somewhat  also  to  the  decomposing  effect  of  the  carbonate  of 
lime  in  the  earth, on  the  sulphate  of  copper. 

M.  Verver  also  planted  balls  made  of  the  mixture  of  the  grain  and  of  arsenic; 
(as  is  frequently  done  by  farmers;)  vegetation  was  not  in  the  least  impeded;  the 
plants  did  not  contain  the  poison,  although  it  was  detected  in  a  soluble  state  in 
the  soil  several  months  thereafter. 

A  similar  result  occurred  when  arsenic  and  arseniate  of  potass  in  powder  were 
inserted  at  the  root  of  growing  plants,  but  watering  them  with  a  solution  of  the 
above  substances  speedily  induced  death. 

From  these  results,  our  author  is  induced  to  believe  that  the  practice  of  farm- 
ers, of  scattering  arsenic  over  their  cultivated  grounds,  in  order  to  destroy  nox- 
ious animals,  cannot  prove  injurious  to  the  cereals  growing  in  them. 

The  examiners  of  the  above  memoirs  seem  notwithstanding  inclined  to  dis- 
suade from  the  use  of  this  dangerous  material. — Bulletin  of  the  Royal  Academy 
of  Brussels,  vol.  8,  May,  1841.  T.  R.  B. 

83.  Superfoiiation. — Mr.  Renauldin  presented  to  the  Academy  a  two-lobed 
uterus,  of  which  the  following  was  the  history.  A  female,  aged  23  years,  six 
months  advanced  in  pregnancy,  aborted.  After  suffering  severe  abdominal  pains 
for  a  week,  she  was  admitted  into  the  Hospital  Beaujon.  M.  Renauldin  found 
her  labouring  under  the  most  marked  symptoms  of  puerperal  peritonitis,  and 
she  died  in  seven  days  thereafter. 

On  dissection,  the  external  organs  and  the  vagina  were  found  to  be  natural, 
but  the  uterus  had  a  double  neck,  and  was  divided  into  two  cavities  completely 
separated  from  each  other,  with  an  ovary,  fallopian  tube  and  ligaments  to  each. 
The  left  cavity,  much  larger  than  the  right,  still  contained  some  bloody  spots, 
and  from  this  the  foetus  is  supposed  to  have  proceeded.  With  such  an  anato- 
mical conformation,  it  is  supposed  that  superfcetation  might  have  occurred. 

The  present  is  a  proper  place  to  mention  that  I  have  read  with  pleasure  the 
article  ^''Generation'''  by  Dr.  Allen  Thomson  in  the  "Cyclopedia  of  Anatomy 
and  Physiology."  In  his  remarks  on  Superfcetation,  he  has  however,  commit- 
ted one  error  of  some  importance,  viz.,  increasing  incorrectly  the  number  of 
extraordinary  cases.  The  first  is  quoted  from  Burdach,  and  related  on  the 
authority  of  Eisenmann.  The  fifth  is  quoted  from  Velpeau,  and  is  related  of  a 
Madame  Bigaux.  Now  these  are  one  and  the  same  case.  Madame  Bigaud 
Vivier  on  the  30th  of  April,  1748,  was  delivered  of  a  living  child,  and  on  the 
16th  of  September  succeeding,  another  of  full  size  and  mature  was  born.  The 
mother,  who  had  also  a  child  in  1752,  died  of  an  acute  disease  in  1755,  and  was 
examined  by  Prof.  Eisenmann,  who  found  the  parts  natural.  There  was  no  double 
uterus.  My  authority  for  this  is  Devergie,  Medecine  Legale,  vol.  1,  p.  489,  1st 
edition.  Desgranges'  case  is  equally  reriiarkable  with  the  above,  but  in  this 
there  was  no  dissection. 

The  following  remarkable  case  is  quoted  in  the  British  and  Foreign  Quarterly 
Review  of  October,  1841,  from  the  communications  of  a  Society  of  Physicians 
practising  at  Riga.  "A  robust  girl  conceived  in  February,  and  in  consequence 
menstruation  ceased.  In  June,  she  aborted.  To  her  dismay,  soon  after  the 
symptoms  of  advanced  pregnancy  appeared,  and  in  the  beginning  of  November, 
five  months  after  the  abortion,  she  was  delivered  of  a  full  grown  child,  which 
doubtless,  was  the  result  of  the  same  impregnation,  as  the  foetus  expelled  at  the 
fourth  month." — Bulletin  of  the  Royal  Jlcademy  of  Medicine  of  jfaris^  sitting 
of  the  21st  of  December,  1841.  T.  R.  B. 

84.  Plea  of  Quick  with  child  in  criminal  cases. — At  a  meeting  of  the  Provin- 
cial Medical  and  Surgical  Association,  held  in  August  last  at  York  in  England, 
the  following  resolution  was  moved  by  Mr.  Griffiths  of  Wexham,  and  carried. 

''  The  attention  of  this  Association  having  been  called  to  the  present  state  of 
the  law  as  it  affects  female  criminals  under  sentence  of  death,  it  desires  to  re- 


k 


1842.]  Medical  Jurisprudence  and  Toxicology.  221 

cord  its  strong  feelings  of  repugnance  to  a  statute,  which  permits  the  woman 
who  has  quickened,  to  plead  pregnancy  in  bar  of  execution;  whilst  the  same 
individual,  though  equally  the  mother  of  a  living  child,  but  not  having  quick- 
ened, must  suffer  the  extreme  penalty  of  the  law;  thus  making  a  distinction 
where  there  is  no  difference,  and  fatally,  though  ignorantly,  sacrificing  an  inno- 
cent life  with  that  of  the  guilty  parent;  and  though  not  prepared  on  the  present 
occasion  to  take  any  decided  steps,  the  Association  fully  recognises  its  obliga- 
tion to  adopt  at  some  future  time  such  measures  as  will,  it  trusts,  lead  to  the 
abrogation  of  a  law,  cruel  in  its  effects,  inconsistent  with  the  progress  of  know- 
ledge and  civilization,  and  consequently  revolting  to  the  feelings  and  claims  of 
humanity." — Edinburgh  and  London  Monthly  Journal  of  Medical  Science,  Sep- 
tember, 1841.  T.  R.  B. 

85.  Presence  of  Lead  in  the  solids  and  fluids. — In  a  case  at  King's  College 
Hospital,  London,  treated  by  Dr.  Budd,  where  the  patient  had  been  a  house 
painter  for  five  years,  and  died  from  colic  and  epilepsy,  ihe  metal  was  detected 
in  the  brain  by  chemical  analysis,  "  but  Mr.  Bowman  could  obtain  no  evidence 
of  it  by  the  microscope."  This  examination  appears  to  have  been  made,  from 
the  fact  stated,  that  in  two  cases  observed  by  Devergie  and  Guibourt,  in  which 
lead  was  detected  in  the  brain,  the  white  matter  of  the  organ  examined  under 
the  microscope  by  M.  Gluck,  was'said  to  be  remarkably  altered  in  its  minute 
structure. 

Dr.  Budd  presents  the  above  case  as  an  illustration  of  the  continued  effects 
of  lead  on  the  system.  It  remains  in  it.  The  poisonous  preparations  of  lead 
do  not  pass  off,  or  at  least  very  sparingly,  in  the  secretions.  "  In  this  respect, 
they  form  a  striking  contrast  with  iodide  of  potassium.  When  the  latter  accu- 
mulates in  the  blood,  it  produces  sneezing,  watery  eyes,  headache  and  a  variety 
of  other  symptoms,  but  it  passes  off  readily  in  the  urine  and  other  secretions, 
and  at  the  end  of  two  days,  if  no  more  of  the  medicine  be  given,  the  symptoms 
vanish.  The  poison  of  lead,  on  the  contrary,  remains  in  the  system,  and  its 
effects  are  consequently  lasting." 

The  fact  that  acetate  of  lead  has  been  lately  detected  in  the  urine,  confirms 
the  idea  that  it  is  the  least  poisonous  of  the  salts  of  this  metal. 

*'  It  is  stated  by  M.  Liebig,  in  his  work  on  Organic  Chemistry,  that  sulphuric 
acid  lemonade— a  solution  of  sugar  rendered  acid  by  sulphuric  acid— is  a  pre- 
servative from  the  injurious  effects  of  lead;  and  that  colic  is  entirely  unknown 
in  all  manufactories  of  white  lead,  in  which  the  workmen  are  accustomed  to 
drink  iU^— London  Medical  Gazette,  December,  1841.  T.  R.  B. 

86.  ChevalUer  on  a  new  mode  of  distinguishing  arsenical  spots  from  antimonial 
spots. — M.  BiscHOFF,  a  Saxon,  mentions  in  the  Fharmaceutisches  Centralblat,  No. 
26,  a  mode  of  distinguishing  arsenical  spots  produced  by  the  apparatus  of  Marsh, 
from  those  of  antimony.  It  is  founded  on  the  property  possessed  by  the  chlo- 
rite of  soda  {liquor  of  Labarraque)  of  dissolving  the  arsenical  ones,  whilst  it 
does  not  affect  the  others. 

Being  desirous  of  ascertaining  the  value  of  this  test,  M.  Che  vallier,  associat- 
ing with  himself  M.  Labarraque,  prepared  on  various  capsules  I.  spots  of 
arsenic;  2.  spots  of  antimony;  and  3.  spots  of  antimony  and  arsenic;  and  they 
found  that  the  arsenical  spots  disappeared  instantly,  when  the  chlorite  of  soda 
came  in  contact  with  them — that  the  antimonial  spots  were  not  altered  in  colour, 
and  finally  that  the  spots  consisting  of  a  mixture  of  the  two,  lost  a  portion  of 
the  colour,  owing  as  they  suppose,  to  a  solution  of  the  arsenic  in  the  chlorite  of 
soda.  This  was  confirmed  by  taking  the  chlorite  laying  on  these  spots,  ad- 
ding muriatic  acid,  and  then  passing  a  stream  of  sulphuretted  hydrogen  through 
it.  A  precipitate  of  sulphuret  of  arsenic  was  obtained,  which  was  entirely  solu- 
ble in  ammonia. 

MM.  Chevallier  and  Labarraque  propose  to  continue  these  observations, 
and  to  ascertain  whether  it  is  not  possible  by  means  of  the  chlorite  of  soda  to 

»19 


222  Progress  of  the  Medical  Sciences.  [July 

separate  arsenic  from  its  combinations  with  other  metals. — Bulletin  of  the  Royal 
Academy  of  Medicine,  meeting  of  the  14th  of  December,  1841.  T.  R.  B. 

87.  Nicotine. — Paris  Academy  of  Sciences,  February  7th,  1842. — M.  Barral 
read  an  extract  of  a  memoir  on  some  experiments  made  by  him  on  tobacco,  and 
on  the  extraction  of  nicotine,  a  substance  discovered  by  Vauquelin  in  1809. 
M.  Barral  had  succeeded  in  obtaining  this  substance  in  a  state  of  purity  and 
had  analyzed  it.  He  found  it  to  be  a  powerful  alkali,  under  the  form 
of  a  liquid,  with  a  very  low  equivalent,  and  therefore  capable  of  great  satura- 
tion, as  compared  with  other  vegetable  alkalies.  It  was  also  a  very  energetic 
poison,  and  taken  in  feeble  doses,  was  found  to  produce  almost  instantaneous 
dQ2ii\\,'-Jlthenxum,  February  19,  1842.  T.  R.  B. 

88.  Ergot — Some  recent  notices  concerning  this  substance,  deserve  a  brief 
summary.  Mr.  Quekett,  who  has  already  investigated  the  cause  of  its  forma- 
tion, and  who,  from  numerous  observations,  attributed  it  to  the  grain  becoming 
infested  with  a  parasitic  fungus,  but  left  the  question  in  doubt,  as  to  the  method 
by  which  this  singular  formation  probably  originates,  is  now  of  opinion,  from 
several  experiments  made  by  him,  that  "  the  absorption  of  the  sporules  of  the 
fungus,  by  the  fibres  of  the  root  of  the  germinating  grain,  will  be  found  to  be 
the  true  cause  of  this  singular  production,  and  that  when  they  arrive  at  the 
grain,  they  convert  it  into  the  body  known  as  the  Ergot." 

By  exposing  wheat  and  barley,  as  well  as  rye  to  the  influence  of  this  fungus, 
the  latter  was  affected,  and  the  two  former  not.  It  is  particularly  liable  to  this 
disease,  and  that  it  becomes  so,  arises  either  from  constitutional  properties  or  its 
anatomical  peculiarities. 

M.  Bonjean  of  Chambery  has  investigated  the  nature  of  ergot.  He  is  of 
opinion,  that  if  gathered  on  the  first  day  of  its  formation,  it  is  not  so  poisonous 
as  when  taken  on  the  sixth — that  a  heat  of  212°  Fah.  also  injures  its  poisonous 
properties,  as  does  also  fermentation.  He  has  discovered  two  active  principles 
in  it.  One  is  the  oil  of  ergot,  of  an  acrid  flavour,  yellowish  colour,  soluble  in 
cold  ether  and  boiling  alcohol.  It  possesses  poisonous  properties  in  a  high  de- 
gree. The  author  considers  that  twelve  grammes  of  this  oil  are  equivalent  to 
thirty-two  grammes  of  the  ergot  of  rye.  A  high  heat,  however,  destroys  these 
violent  properties,  and  converts  it  into  a  resin.  It  is  better  therefore  to  prepare 
it  with  cold  ether.  The  second  is  the  aqueous  extract  which  is  obtained  by 
treating  the  powder,  deprived  of  its  oil  or  not,  with  water.  It  is  brown,  of  a 
thick  consistence  and  musty  smell.  It  is  soluble  in  water,  and  can  be  formed 
into  mixtures,  syrups  and  pills.  It  is  not  at  all  poisonous,  but  possesses  anti- 
hemorrhagic  properties, — London  Medical  Gazette,  October  1841,  and  January, 
1842.  T.  R.  B. 

89.  Suicide  from  Asphyxia  hy  choking,  from  the  introduction  of  a  firm  plug  into 
thefauces. — Mary  Ann  Palmer,  a  female  in  good  health,  aged  29  years,  was 
found  dead  in  her  sleeping  apartment.  The  cavities  of  the  head,  chest  and 
abdomen  were  examined,  and  the  medical  certificate  was  that  she  had  died  of 
(simple)  apoplexy.  The  body  was  received  by  Dr.  Handyside,  Lecturer  on 
Surgery  at  Edinburgh,  for  public  dissection,  in  accordance  with  the  provisions 
of  the  Anatomy  Act. 

Dr.  Handyside  noticexl  the  appearance  of  the  brain,  but  found  nothing  ade- 
quate to  account  for  death.  Twenty-six  days  after  receiving  the  body,  he  had 
occasion  to  demonstrate  the  muscular  structure  of  the  pharynx,  and  for  this  pur- 
pose, introduced  his  finger  into  the  back  part  of  the  mouth,  in  order  to  stuff  that 
cavity  with  hair.  But  he  found  that  space  already  pre-occupied  by  a  dense 
foreign  substance,  apparently  round  in  form,  and  impacted  between  the  root  of 
the  tongue  and  the  soft  parts,  so  very  firmly,  as  to  have  cut  off  the  supply  of  air 
to  the  lungs,  by  forcibly  closing  the  mouth,  and  posterior  nares. 

He  dislodged  this  body  with  considerable  difficulty,  and  found  it  to  consist  of 
portions  of  soft  cotton,  called  spindle  ends.    These  were  recognized  by  the  par- 


1842.]  Medical  Jurisprudence  and  Toxicology,  223 

ties  interested,  as  having  been  used  by  the  deceased  in  the  solitary  employment 
which  she  pursued  at  her  death.  Some  of  this  cotton  she  had  untwisted  and 
rolled  up  very  closely,  coiling  over  it  two  strips  of  flannel,  vv'hich  she  had  bor- 
rowed the  last  time  she  was  seen  in  life.  Finally,  she  had  fastened  these 
materials  tightly  together,  by  means  of  a  large  rough  pin.  The  ping,  when 
removed,  presented  a  conical  shape,  somewhat  curved,  of  3^  inches  in  length, 
1|  inch  in  breadth  at  its  base,  and  three-fourths  of  an  inch  in  breadth  at  its 
apex. 

Among  the  interesting  circumstances  attending  the  case,  were  the  facts,  that 
on  inspecting  the  interior  of  the  mouth,  the  soft  palate  presented  on  the  left  side 
of  the  uvula  (the  part  corresponding  with  that  portion  of  the  plug  where  the 
rough  head  of  the  pin  projected)  a  small  though  deep  laceration  of  its  texture, 
and  which,  although  twenty-eight  days  had  elapsed  since  death,  was  surrounded 
by  a  circumscribed  patch  of  ecchymosis^  that  remained  still  of  a  vermilion  hue. 
The  right  side  of  the  soft  palate  was  similarly  ecchymosed,  but  not  lacerated. 
The  surfaces  of  the  anterior  fourth  of  the  tongue,  and  the  hard  palate  opposite 
to  it — parts  which  had  been  compressed  by  the  broad  and  round  base  of  the  plug 
— exhibited  each  a  transverse  band  of  ecchymosis,  but  paler  than  in  the  former. 
Lastly,  the  epiglottis  and  arytenoid  cartilages,  which  appeared  to  have  been 
violently  separated  by  the  last  expiration,  and  were  retained  apart  by  the  narrow 
and  rough  extremity  of  the  plug,  exhibited  diflused  ecchymoses,  as  evidenced 
by  the  traces  of  coagulated  blood  that  on  dissection  were  displayed  underneath 
the  mucous  membrane  investing  the  larynx. 

It  is  necessary  to  understand,  that  death  in  this  case  occurred  on  the  27th  of 
December,  and  also  (although  Dr.  Handyside  does  not  appear  to  attach  any  im- 
portance to  this)  that  a  solution  of  nitre,  an  ounce  to  a  pound  of  water,  had 
been  introduced  along  with  the  ordinary  injection  materials,  into  the  arteries  of 
the  body. 

The  importance  of  inspecting  all  the  cavities  of  the  body  in  medico-legal 
cases,  is  forcibly  urged  from  a  review  of  this  case.  "  It  is  to  be  remembered 
that  in  every  case  of  death  by  choking,  smothering,  or  strangulation,  the  natural 
appearances  of  the  body  are  not  necessarily  altered.  Accordingly,  in  the  pre- 
sent instance  the  surface  of  the  great  cavities  of  the  body  appeared  to  be  perfect- 
ly healthy  in  their  structure  and  contents." — Edinburgh  Med,  and  Surg.  Journ, 
April,  1842.  T.  R.  B. 

90.  Minute  quantity  of  Opium  destructive  to  the  life  of  a  child. — Mr.  Everest 
delivered  a  woman  of  a  healthy  female  child,  and  prescribed  a  draught  composed 
of  twelve  minims  of  laudanum  in  an  ounce  of  pimento  water  to  relieve  the  after 
pains.  Two  days  after,  on  calling,  the  nurse  told  him  that  she  had  given  the 
child  half  a  teaspoonful  of  the  draught  prepared  for  the  mother,  in  order  to  com- 
pose it,  and  to  prevent  its  crying.  The  child  was  labouring  under  all  the  symp- 
toms of  poisoning.  Stimulants  and  artificial  respiration  were  employed  with 
some  benefit,  but  the  coma  returned,  and  the  child  finally  died  in  fourteen  hours 
after  taking  the  laudanum.  In  this  case,  a  child  two  days  old  was  destroyed  by 
a  minim  and  a  half  oi  laudanum.  Dr.  Christison  mentions  as  the  smallest  fatal 
dose,  that  of  a  child  three  days  old,  who  took  by  mistake,  about  the  fourth  part 
of  a  mixture  containing  ten  drops  of  laudanum.  Dr.  Kelso  relates  a  case  (Lan- 
cet, N.  S.  vol.  21,  p.  304,)  where /our  drops  of  laudanum  given  to  a  child  nine 
months  old,  were  probably  the  cause  of  death. — Lancet,  February  26,  1842. 

T.  R.  B. 

91.  Signs  of  Pregnancy. — Kiesteine. — Mr.  Letheby  states  that  out  of  fifty 
cases  experimented  on  by  him,  at  all  dates  between  the  second  and  ninth  month 
of  utero-gestation,  he  obtained  unquestionable  evidence  of  its  presence  in  forty- 
eight. 

In  seventeen  non-pregnant  women,  there  was  no  indication  of  its  presence. 
In  examining  the  urine  of  ten  women  during  the  time  of  suckling,  he  found  it 


224  Progress  of  the  Medical  Sciences.  [July 

in  all  immediately,  after  delivery,  but  the  evidence  of  its  existence  fell  off  at  a 
period  between  the  second  and  sixth  months. 

He  directs  that  the  urine  be  obtained  when  the  female  is  as  free  from  disease 
as  possible,  and  that  passed  early  in  the  mornincr  should  be  selected.  Expose 
this,  in  a  tall  narrow  glass,  to  a  temperature  of  about  70°  Fah.  A  much  lower 
temperature,  as  40°,  will  delay  its  production  for  weeks.  In  two  or  three  days,  if 
the  woman  be  pregnant,  the  first  indication  is  turbidness.  In  a  day  or  two  more, 
a  thin  pellcle  forms  on  the  surface,  and  this  gradually  acquires  consistence  up 
to  a  fortnight.  The  odour  is  peculiar,  not  like  cheese,  as  Dr.  Bird  states,  but 
like  that  of  our  beef  beginning  to  putrify. 

The  peculiar  pellicle  needs  not  to  be  confounded  with  others,  and  common 
ones.  The  liihates  give  out  the  smell  of  ammonia,  and  when  disturbed  fall  to 
the  bottom.  Neither  of  these  occurs  with  kiesteine.  Lond.  Med.  Gaz.,  Decem- 
ber, 1841.  T.  R.  B. 

92.  New  Test  for  Nitric  Jlcid. — The  difficulty  of  finding  a  distinctive  test  for 
this  substance  is  acknowledged  by  most  writers  on  Toxicology,  and  we  are  in 
doubt  whether  the  present  will  materially  aid  in  removing  it.  The  substance 
prepared  (by  a  writer  in  the  Chemist,  a  recent  periodical)  is  the  hydrargyro- 
cyanide  of  iodide  of  potassium.  It  is  formed  by  mixing  cyanuret  of  mercury 
and  iodide  of  potassium  together,  in  their  equivalent  proportions,  and  dissolving 
the  salt  in  small  quantities  of  warm  water,  from  which,  on  cooling,  it  is  depo- 
sited in  beautiful  plates. 

If  one  of  its  scaly  crystals  be  put  into  most  of  the  acids,  as  the  sulphuric, 
muriate,  hydrofluoric,  chromic,  phosphoric,  and  the  common  vegetable  acids,  it 
immediately  becomes  of  a  beautiful  red,  being  changed  into  biniodide  of  mer- 
cury, but  in  concentrated  nitric  acid,  of  the  specific  gravity  1.4  to  1.5,  the  scale 
almost  instantly  becomes  black,  from  the  liberation  of  iodine.  This  effect  is 
visible  upon  a  very  small  portion  of  the  salt. 

It  has  been  found  also  to  blacken  with  chlorine,  bromine,  sulphuretted  hydrogen, 
nitrous  acid,  ^c. — It  is  recommended,  in  case  we  suspect  the  presence  of  a  nitrate, 
to  evaporate  its  solution  to  dryness,  introduce  a  portion  of  the  residue  into  a  small 
tubulated  retort,  pour  upon  it  one  or  two  drops  of  sulphuric  acid,  apply  a  gentle 
heat,  when  a  portion  of  the  volatile  products  will  pass  over  into  the  receiver 
with  which  the  retort  is  to  be  connected,  and  in  which  one  or  two  crystals  of 
the  salt  have  been  placed.  If  they  are  blackened,  the  substance  tested  is  to  be 
deemed  a  nitrate,  provided  the  presence  of  those  substances  which  might  cause 
the  same  effect  have  been  guarded  against.  The  evolution  of  peroxide  of  chlo- 
rine from  a  chlorate,  and  the  odour  of  a  sulphuret  will  decide  w-ith  regard  to 
these. — Edinburgh  Monthly  Journal  of  Medical  Science.  T.  R.  B. 

93.  Are  medical  men  liable  to  punishment  if  they  refuse  to  make  a  medico-legal 
dissection,  or  a  chemical  analysis,  when  called  upon  by  the  coroner?  I  have  sup- 
posed not,  and  have  so  stated. — It  might  seem  at  first  view  to  be  their  duty  as 
citizens  to  further  the  purposes  of  justice,  but  this  argument  loses  all  its  weight, 
when  we  recollect  that  no  provision  is  made  in  any  of  our  states  for  their  remu- 
neration.    Every  other  officer  of  justice  is  paid. 

But  suppose  the  law  provides  for  the  payment  of  services,  can  a  physician 
be  then  obliged  to  perform  one  or  the  other  duty]  Can  the  coroner,  (or  the  offi- 
cer charged  with  the  duty  of  holding  inquests)  select  a  particular  individual, 
demand  his  attendance  for  the  above  purpose,  and  in  case  he  refuses,  complain 
of  him  as  guilty  of  a  misdemeanour'?  I  put  these  questions,  in  order  to  intro- 
duce the  narrative  of  the  following  case  which  occurred  in  Belgium  in  1839. 

On  the  llthof  December,  Dr.  Cambrelin  of  Namurat4  P.M.  was  waited  upon 
by  a  subordinate  officer  of  police,  with  a  blank  subpoena  signed  by  the  chief 
police  officer  requiring  him  to  examine  the  body  of  anew-born  infant,  which  had 
been  found  dead  that  morning  in  a  heap  of  peat,  lying  in  the  kitchen  of  a  house 
in  the  city.  Dr.  C.  observed  to  the  officer  that  the  requisition  was  in  blank,  and 
in  reply  was  informed,  that  it  had  been  presented  to  a  number  of  physicians 


1842.]  Medical  Jurisprudence  and  Toxicology.  225 

since  morning,  and  that  all  had  declined,  including  the  individuals  who  had  for 
the  last  ten  years,  been  engaged  in  medico-legal  examinations  by  authority. 
And  the  officer  now  proposed  that  if  he  would  accept,  his  name  should  be  in- 
serted, and  he  would  thus  become  entitled  to  the  usual  fee.  Dr.  Cambrelin 
declined  assenting  to  this,  and  waited  upon  the  Commissary  of  Police.  To  him, 
he  stated,  that  he  had  not  particularly  attended  to  medico-legal  investigations 
during  the  last  ten  years — that  the  inquiry  in  question  was  a  difficult  one,  par- 
ticularly as  many  new  points  had  been  discussed  within  the  period — that  as  the 
evening  was  rapidly  coming  on,  some  difficulties  would  be  encountered  in  deter- 
mining the  condition  of  ihe  various  organs  to  be  examined  by  candle-light,  and 
above  all,  that  the  duty  properly  belonged  to  the  medical  officer,  who  had  for 
years,  attended  to  medico-legal  dissections. 

The  Commissary  in  reply  threatened  to  complain  of  him  to  the  tribunal  of 
police,  unless  he  immediately  undertook  the  examination.  Dr.  Cambrelin  an- 
swered, make  then  your  complaint. 

When  brought  before  the  court,  he  presented  the  above  points  of  defence, 
with  others,  but  was  found  guilty  of  an  infraction  of  the  475th  article  of  the 
Penal  Code,  which  is  of  the  following  import: 

An  individual  may  be  fined  from  six  to  ten  francs,  who  shall  refuse  or  neglect 
to  give  the  necessary  assistance,  when  required,  in  cases  of  accidents,  ship- 
wrecks, inundations,  as  also  in  cases  of  robberies,  of  individuals  taken  in  the 
fact  of  committing  crimes  {Jlagrante  delicto)  hue  and  cry,  and  judicial  acts,  (Exe- 
cution judiciare.) 

It  was,  doubtless,  under  the  last  clause  that  this  decision  was  justified.  Dr. 
Cambrelin  in  an  able  argument  proves  it  to  be  arbitrary  and  unjust,  and  declares 
his  intention  of  appealing  to  the  superior  court. — Innales  D'' Hygiene^  October 
1840.  T.  R.  B. 

94.  Poisoning  with  flour  containing  had.  By  Dr.  Schillbach  {Frorieps 
Nolizen).  Six  members  of  a  family  were  suddenly  seized  with  obstinate  con- 
stipation, uneasiness,  vomiting,  colic;  to  these  symptoms,  succeeded  spasms 
and  pains,  principally  of  the  liands  and  feet,  remarkable  emaciation,  paleness  and 
anxiety.  The  eldest  son,  who  suffi?red  most,  presented  dilatation  of  the  pupils, 
paralytic  rigidity  of  the  limbs,  retraction  of  the  abdomen,  a  livid  complexion 
and  excessive  emaciation.  It  was  supposed  that  these  symptoms  arose  from 
poisoning  with  lead,  but  without  the  least  trace  of  that  poison,  until  at  last, 
there  was  found  in  the  cupboard  where  the  family  kept  their  flour,  a  box  full  of 
small  shot.  As  this  box  was  cracked,  it  was  supposed  that  a  certain  quantity 
of  the  lead  had  fallen  into  the  flour,  and  accordingly  an  analysis  of  the  small 
portion  of  the  flour  that  still  remained  showed  traces  of  this  metal.  The  pa- 
tients gradually  recovered  after  treatment  with  calomel  and  opium,  and  other 
medicines.  The  author  cites  as  illustrative  of  the  above,  a  case  of  severe  lead 
colic,  brought  on  by  drinking  wine  from  a  bottle  which  had  contained  some 
grains  of  lead.— Edinburgh  Monthly  Journ.  of  Med.  Sci.  T.  R.  B. 

95.  On  the  varieties  observed  in  the  symptoms  of  poisoning  with  Opium.  By 
David  Skae,  Lecturer  on  Forensic  Medicine. — Period  at  which. stupor  occurs. 
If  solid  opium  has  been  swallowed,  it  commonly  commences  from  half  an  hour  to 
an  hour.  In  a  case,  however,  by  Desruelles,  where  two  drachms  of  solid  opium 
had  been  taken,  the  stupor  was  complete  in  fifteen  minutes,  and  on  the  other 
hand,  in  the  case  where  the  largest  quantity  was  swallowed  which  has  been  re- 
corded (American  Medical  Recorder,  vol.  13),  viz.  eight  drachms  of  crude  opium, 
the  patient  was  able,  an  hour  afterwards,  to  tell  her  physician  connectedly,  what 
she  had  done.  Wlien  the  poison  has  been  taken  in  solution,  or  in  the  form  of 
tincture,  it  acts  more  rapidly.  In  several  instances,  hopeless  coma  has  been 
completely  formed  in  half  an  hour,  and  the  poison  must  have  begun  to  act  in  ten 
or  fifieen  minutes.     An  example  of  this  will  be  presently  stated. 

Sleep  seems  to  retard  the  operation  of  opium,  provided  it  occurs  immediately 
after  taking  it.     There  are  several  instances  on  record  of  this  description.     In 


226  Progress  of  the  Medical  Sciences,  f*'^"!/ 

one  that  occurred  to  Dr.  Skae,  half  an  ounce  of  laudanum  was  taken,  the  indi- 
vidual slept  thereafter  for  an  hour,  and  then  arose  from  bed  and  procured  a  drink 
for  himself,  yet  in  about  ten  hours  afterwards  he  died  with  all  the  symptoms  of 
narcotic  poisoning. 

Spontaneous  vomiting  occasionally  takes  place.  Convulsions  rarely,  but  when 
they  do  occur  they  are  violent,  and  in  only  occasional  instances,  accompanied 
with  delirium.  Diarrhoea  and  colic,  in  some  cases,  and  diuresis  in  others,  now 
and  then  happen,  although  ordinarily  the  opposite  effects  are  produced. 

Death  usually  follows  in  from  seven  to  twelve  hours.  There  are  instances, 
however,  in  which  life  was  prolonged  for  fifteen,  seventeen,  and  twenty-four 
hours,  and  again  individuals  have  died  in  five,  four,  or  three  hours. 

The  following  remarkable  case  varies  in  several  respects  from  the  usual 
course  of  symptoms.  A  soldier  in  the  29th  Regiment  stationed  in  Edinburgh 
Castle  took  two  and  a  half  ounces  of  the  liquor  opii  sedativus,  twenty  minutes 
before  nine  P.  M.  He  was  seen  a  quarter  of  an  hour  thereafter  by  Dr.  Cooper, 
the  surgeon,  who  found  him  totally  insensible.  The  face  was  purple,  and  the 
features  distorted,  the  pupils  dilated  and  insensible,  the  breathing  stertorous  and 
accompanied  with  hiccough,  and  the  pulse  slow  and  small.  The  stomach  was 
emptied  and  washed  out  by  means  of  the  stomach  pump,  and  the  other  remedies 
usual  in  such  cases  were  adopted,  but  the  man  expired  at  ten  P.  M.,  an  hour  and 
twenty  minutes  after  swallowing  the  poison.  The  body  was  examined  carefully, 
and  with  the  exception  of  tiie  liver,  which  exhibited  extensive  disease  of  old 
standing,  no  morbid  appearances  of  any  note  were  found.  The  blood-vessels 
within  the  cranium  contained  a  considerable  quantity  of  blood,  and  some  serous 
fluid  was  found  in  the  lateral  ventricles.  The  fingers  and  toes  were  contracted, 
and  still  rigidly  retained  their  positions.  From  this  circumstance,  and  from  the 
distortion  of  the  features  during  life,  it  may  be  conjectured  that  the  individual 
died  partially  convulsed.  It  is  probably  the  most  rapidly  fatal  case  on  record. — 
Edin.  Monthly  Journ.  of  Med.  Sci.  T.  R.  B. 

96.  Advanced  stage  of  the  Putrefaction  of  the  Brain,  ivithout  any  corresponding 
appearances  in  the  rest  of  the  body. — M.  Millet  calls  the  attention  of  medical 
jurists  to  the  facts  of  the  following  case.  On  the  29ih  of  August,  1840,  an  in- 
dividual (a  patient  of  M.  Leuret)  labouring  under  dementia  and  general  para- 
lysis expired.  The  body  was,  a  few  hours  thereafter,  removed  to  a  cool  room 
and  laid  on  a  zinc  table.  Here  it  remained  during  forty-one  hours,  when  the 
dissection  commenced.     The  temperature  was  about  86°  of  Fahrenheit. 

The  dura  mater  was  found  strongly  adhering  in  several  places.  After  separat- 
ing it,  and  opening  into  the  brain,  the  cerebral  mass  of  both  hemispheres  was 
seen  converted  into  a  yellowish-green  fluid  streaked  with  blood,  of  an  offensive 
and  penetrating  odour.  In  the  midst  of  this  putrid  mass,  near  the  left  corpus 
striatum,  there  was  a  portion  more  solid  and  resisting,  evidently  the  result  of  a 
ruptured  vessel  (wn  foyer  apoplectique.)  It  was  surrounded  by  a  number  of 
whitish  vesicles,  which  on  being  opened,  discharged  a  brick-red  matter. 

When  the  cerebral  mass  was  spread  on  the  table,  it  was  scarcely  possible  to 
distinguish  any  of  the  circumvolutions— so  complete  had  been  the  progress  of 
putrefaction.  Indeed  the  lower  part  of  the  brain  was  green,  and  more  spotted 
than  the  upper.  The  cerebellum  was  also  in  a  state  of  complete  solution,  and 
even  the  spmal  marrow,  on  being  traced,  was  in  a  similar  condition  and  of  a 
gray  colour  passing  to  green. 

On  the  other  hand,  the  right  lung  was  healthy,  but  engorged;  the  left  lung 
bore  the  marks  of  effusion,  with  some  recently  formed  membranes;  the  heart 
was  flaccid  and  discoloured;  the  stomach  and  intestines  healthy;  the  liver  and 
spleen  a  little  softened  and  enlarged;  the  muscles  of  the  trunk  and  extremities 
firm  and  hard;  and  the  external  appearance  as  usual  in  a  dead  body,  except  that 
the  skin  of  the  superior  extremities  was  slightly  greenish. 

Mr.  Millet  inquires,  if  the  head  of  this  individual  had  been  separated  from  the 
body  (as  in  a  case  of  assassination),  any  medical  jurist  would  have  recognized 
their  connection,  or  whether  he  would  assign  so  short  a  period  since  death,  as 
two  day  si —^mia/es  D' Hygiene  January,  1841.  T.  R.  B. 


1842.]  Medical  Jurisprudence  and  Toxicology,  '     237 

97.  Birth  of  a  living  child  on  the  179/A  day. — The  following^  case  is  probably 
as  well  authenticated  both  by  facts  and  attendant  eircutnstances,  as  any  that 
have  been  already  published.  Mrs.  R.  a  well-formed  woman,  aged  21  years, 
stated  that  she  was  married  July  22,  1839,  that  she  menstruated  naturally  the 
week  before  marriacje,  but  that  the  menses  had  never  after  returned.  About 
three  weeks  previous  to  the  evenino-  on  which  she  experienced  the  first  pains 
of  labour,  she  stumbled  and  fell,  and  was  instantly  seized  with  a  pain  in  her 
back,  that  had  never  entirely  left  her.  She  suffered  also  under  frequent  nausea 
and  rigors.  Mr.  Tait,  who  relates  the  case,  was  called  to  her  on  the  17th  of 
January  1840,  and  the  birth  ensued  in  about  seven  hours  after  the  commence- 
ment of  labour. 

The  child,  a  female,  was  so  extremely  feeble,  that  no  one  supposed  it  would 
survive.  Its  cry  was  so  weak,  as  to  be  heard  only  for  a  few  yards;  there  were 
no  nails  on  its  fingers  or  toes;  a  thick  down  covered  the  head  instead  of  hair; 
the  skin  everywhere  was  unusually  florid  and  thin;  and  the  extremities  imper- 
fectly developed;  the  bones  of  the  head  were  soft  and  easily  compressed,  and  their 
approximation  at  the  sutures  was  imperfect.  The  membranas  pupillares  were 
entire.  The  child  was  wrapped  in  soft  cotton,  and  kept  in  a  basket  near  the 
fire.  It  was  so  feeble,  as  to  be  unable  to  grasp  the  mother's  nipple,  and  for  the 
first  three  weeks,  was  nursed  by  milk  taken  from  the  breast,  introduced  at  first 
by  a  quill,   and  afterwards  by  a  teaspoon. 

As  soon  as  it  began  to  suck,  its  whole  appearance  improved,  and  hopes  were 
now  entertained  of  rearing  it.  It  was  first  accurately  weighed  and  measured  on 
the  27th  of  February,  forty  days  after  birth,  and  the  result  was— weight,  three 
pounds;  length,  thirteen  inches;  centre  of  the  body,  nearly  an  inch  above  the 
umbilicus. 

March  \&th. — The  child  was  weighed  a  second  time  in  the  presence  of  Pro- 
fessor Simpson  of  Edinburgh.  Its  length  was  now  13J  inches;  weight,  three 
pounds,  ten  ounces  and  a  half;  centre  of  the  body  three-quarters  of  an  inch 
above  the  umbilicus.  As  it  w.as  labouring  under  purulent  ophthalmia,  it  was 
impossible  to  ascertain  whether  the  membranae  pupillares  had  undergone  any 
change.  The  appearance  was,  however,  improved,  and  it  cried  with  a  stronger 
voice,  though  still  feebler  than  children  usually  do. 

Jlpril  Wlh. — Weighed  again.  Weight,  five  pounds  three  ounces;  length, 
seventeen  inches;  centre  of  the  body  at  the  superior  margin  of  the  umbilicus. 
The  nails  are  now  formed  on  the  fingers  and  toes,  and  the  down  or  hair  has 
almost  entirely  disappeared  from  every  part  of  the  body. 

From  this  period  it  continued  to  thrive,  until  the  27th  of  May,  when  it  was 
seized  with  measles,  and  died  after  two  days'  slight  illness. — Lancet,  April  23, 
1842.  T.  R.  B. 

98.  Child  horn  at  the  end  of  the  fifth  month,  which  lived  six  days — Dr.  John 
Cochrane,  of  Edinburgh,  relates  an  interesting  case  of  this  in  the  Lon.  and  Ed. 
Monthly  Journ.  Med.  Set.  (March,  1842),  which  we  have  to  regret,  however,  is 
imperfect  in  its  details. 

Mrs.  B.  about  the  end  of  her  fifth  month  of  pregnancy,  was  delivered  by  Dr. 
C.  of  a  male  child,  on  the  morning  of  the  19th  of  October,  1841.  The  child 
did  well  until  the  night  of  the  25th,  when  he  died.  "  He  thus  completed  nearly 
six  days,  during  which  he  passed  the  urine  and  feeces  in  a  natural  way,  and 
seemed  likely  to  thrive  as  well  as  a  child  come  to  the  full  time. 

The  testes  had  not  descended.  The  weight  was  only  two  pounds  and  eight 
ounces;  the  length  of  the  body  was  only  14  inches;  the  circumference  of  the 
chest  was  nine  inches;  the  length  from  the  vertex  to  the  point  of  the  nose  six 
inches;  and  the  occipito-frontal  circumference  eight  inches.  Considering  the 
very  small  weight  of  the  body,  it  is  certainly  remarkable  that  the  child  lived  so 
long  as  he  did. 

A  post-mortem  examination  was  not  allowed. 


228  Progress  of  the  Medical  Sciences,  [^"^7 

99.  Recovery  from  taking  two  drachms  of  Arsenic. — Mr.  Toogood  relates  the 
following  example  of  this.  W.  R.  aged  17,  swallowed  two  drachms  of  arsenic, 
which  he  coarsely  bruised  with  the  end  of  a  bottle  at  nine,  P.  M.,  on  the  2d  of 
June,  1817,  with  a  view  to  self-destruction.  He  repented,  and  made  it  known 
a  quarter  of  an  hour  afterwards.  Six  grains  of  emetic  tartar  were  immediately 
given  and  quickly  repeated.  Vomiting  was  soon  excited,  and  briskly  kept  up, 
by  copious  draughts  of  warm  water  for  two  hours.  Nothing  was  retained  on 
the  stomach  during  the  night,  and  he  complained  of  constant  and  severe  pain  in 
the  stomach  and  bowels.  He  passed  the  night  without  rest,  and  on  the  follow- 
ing morning  he  complained  still  of  great  pain  in  his  stomach  and  bowels,  was 
very  hot,  with  a  frequent  pulse  and  flushed  countenance.  He  was  copiously 
bled,  and  his  bowels  were  relieved  by  injections,  but  nothing  could  be  retained 
on  the  stomach  until  the  evening  after  the  application  of  a  blister.  Effervescing 
medicines,  with  opium,  were  then  kept  with  difficulty,  but  he  was  not  so  much 
relieved  until  the  fourth  to  make  his  recovery  certain. — Prov*  Med.  and  Surg. 
Journ.  January  1,  1842. 


MISCELLANEOUS. 

100.  .Animal Magnetism. — After  an  interesting  and  judicious  paper  read  to  the 
Westminster  Medical  Society,  by  Mr.  Longmore,  condemnatory  of  animal  mag- 
netism, the  discussion  was  much  enlivened  by  the  practical  exhibition  of  the  mes- 
meric treatment  upon  a  susceptible  subject,  one  of  the  members  of  the  society,  who 
was  well  known,  and  beyond  suspicion.  The  subject  of  the  experiment  was  a 
young  gentleman  of  about  nineteen  years  of  age,  of  the  sanguine-nervous  tem- 
perament, robust,  and  healthy.  Having  taken  a  seat  at  the  table,  the  chairman 
entered  into  conversation  with  him,  obviously  for  the  purpose  of  removing  any 
agitation  that  might  exist,  that  the  experiment  might  be  fairly  conducted.  The 
society  was  informed  that  one  of  the  peculiar  features  of  this  case  was  the 
power  the  individual  possessed  of  inducing  upon  himself  the  ^^crisis,''^  or  the 
"mesmeric  sleep,"  without  manipulation,  or  the  intervention  of  a  second  party. 
Having  taken  his  seat  in  the  area,  he  showed  the  society  how  he  could  induce 
the  "crisis."  He  held  a  pen  towards  the  point  of  his  nose,  and  fixed  his  eyes 
(which  necessarily  squinted  a  little)  upon  the  pen,  but  his  fins^er  he  said  would 
do  equally  well.  Having  continued  steadfastly  gazing,  as  it  were,  at  the  point 
of  his  nose  for  about  forty  or  fifty  seconds,  he  fell  back  upon  the  chair  in  a  fit 
similar  to  that  of  epilepsy,  with  this  difference,  that  the  muscles  of  his  face 
were  not  distorted,  nor  was  there  any  foaming  at  the  mouth.  The  muscles  of 
the  trunk  and  limbs  were,  however,  rigid;  his  pulse  quick  and  irregular;  the 
pupils  dilated,  and  the  tips  of  his  fingers  ice-cold.  When  an  arm  or  leg  was 
raised,  it  remained  out-stretched  and  rigid  in  the  position  in  which  it  was  placed, 
as  in  cataleps)^  While  sitting  on  the  chair  with  his  head  much  drawn  back- 
wards over  the  back  of  the  chair,  first,  one  arm  was  raised  by  an  assistant 
evidently  with  some  difficulty  from  the  rigidity  of  the  muscles,  till  the  limb  was 
at  right  angles  with  the  trunk,  when  it  remained  fixed  in  that  position.  The 
other  arm  was  then  raised  in  a  similar  manner,  and  left  fixed  at  a  similar  angle. 
It  was  proposed  then  to  try  the  effects  of  lifting  the  legs.  While  the  young 
man  was  still  sitting  with  his  arms  projecting  forwards  at  right  angles,  one  foot 
was  first  raised  till  the  whole  lower  limb  projected  forwards  upon  a  level  with 
the  seat  of  the  chair;  the  other  foot  was  then  treated  in  a  similar  manner,  and 
the  four  limbs  left  in  these  awkward  positions  for  a  much  longer  period  than 
could  be  maintained  by  any  voluntary  effort.  He  was  aroused  after  some  mi- 
nutes by  a  smart  stroke  upon  one  of  the  outstretched  limbs,  and  appeared  much 
confused  and  bewildered,  but  soon  regained  his  usual  appearance.  Soon  after- 
wards the  chairman  tried  upon  him  the  usual  manipulations,  but  with  the  backs 
of  the  hands  instead  oi  ihe  palms;  a  process  which  is  said  to  be  entirely  useless, 
or  inadequate  to  produce,  according  to  the  adepts,  any  mesmeric  effects  what- 


1842.] 


Miscellaneous,  229 


ever.  While  these  passes  were  being  made,  the  chairman  inquired  how  the 
young  man  felt;  and  he  replied,  that  he  had  a  sensation  as  if  electricity  was 
passing-  through  him.  The  chairman  then  pointing  with  his  forefinger  to  the 
forehead  of  the  young  man,  requested  him  to  look  steadfastly  at  his  (the  chair- 
man's) finger,  which  he  did,  and  in  less  than  a  minute  he  dropped  in  a  "cmzs.'" 
The  rigidity  of  the  muscles  was  as  great  as  in  the  former  experiment,  and  no 
doubt  could  be  entertained  that  the  young  man  was  totally  insensible  to  ail  that 
was  passing  around  him.  This  was  proved  to  the  satisfaction  of  the  society  by 
various  experiments  upon  the  skin  and  upon  the  eye.  After  numerous  trials  of 
the  state  of  his  sensibility,  the  young  man  was  lifted  and  placed  erect  upon  his 
feet,  and  held  in  that  position  for  some  time,  every  muscle  being  apparently  in 
a  rigid  state  of  contraction.  After  remaining  for  some  minutes  in  this  cataleptic 
state,  he  was  roused  as  before  by  a  smart  blow  upon  the  arm;  and  though  stand- 
ing still  upon  his  feet,  he  appeared  when  thus  struck  to  be  aroused  from  a  deep 
sleep,  and  seemed  at  first  amazed  at  what  was  going  on  around  him. 

The  chairman  having  been  requested  by  the  society  for  an  explanation  of  the 
phenomena  just  witnessed,  said,  although  he  doubted  whether  a  satisfactory 
answer  could  be  given,  it  was  to  him  perfectly  obvious  that  the  phenomena  were 
not  attributable  to  any  new  agency  developed  and  introduced  into  the  system 
of  the  young  man,  for  the  fit  could  obviously  be  induced  by  the  young  man 
himself  more  quickly  than  by  the  agency  of  another.  Whatever  might  be  the 
cause  of  the  lit,  it  could  not  possibly  be  attributable  to  animal  magnetism,  or  to 
any  extrinsic  cause.  According  to  the  chairman  it  depended  upon  a  peculiar 
state  or  idiosyncrasy  of  the  nervous  system — the  epileptic, — which  might  be 
called  into  activity  by  various  causes,  as  mental  emotion,  imagination,  a  habit 
of  recurrence  by  the  induction  of  some  oi  \\\e  precursory  movements  of  epilepsy, 
or  even  by  inducing  a  peculiar  state  of  a  single  nerve.  The  chairman  was  in- 
clined to  attribute  the  phenomena  in  the  case  before  the  society  to  the  last  of 
these  causes.  A  peculiar  impression  was  first  induced  on  the  optic  nerves  of  the 
young  man,  by  the  fixing  steadily,  and  for  some  time,  the  eyes  upon  a  given 
point:  a  state  similar  to  that  induced  by  pressure  upon  the  nerves  of  a  limb 
when  a  numbness  or  "  sleeping"  of  the  limb  occurs.  The  state  of  the  optic 
nerve  thus  induced,  he  conceived,  was  transmitted,  by  continuous  sympathy,  to 
the  brain  and  whole  nervous  system,  with  its  necessary  effects  upon  conscious- 
ness and  the  motive  and  sensitive  powers. 

The  subject  excited  considerable  discussion,  and  the  majority  of  the  speakers 
concurred  with  the  essayist  in  the  views  he  supported  in  opposition  to  animal 
magnetism. — Lancet^  1842. 

101.  Abstract  of  a  paper  on  Opium  smoking  in  China,  By  G.  H.  Smith,  Esq., 
Surgeon  in  Penang.  Communicated  to  Dr.  Johnson  by  the  author. — The  great 
extent  to  which  this  destructive  vice  is  carried  on  in  this  island,  and  in  the  straits 
and  islands  adjacent,  together  with  the  almost  utter  impossibility  of  relinquish- 
ing the  dreadful  habit,  when  once  acquired,  opens  an  immense  source  of  revenue 
to  the  East  India  Company,  who  monopolize  the  sale  of  all  quantities  of  opium 
under  a  chest,  as  well  as  that  of  arrack,  seree,  toddy,  bang,  &c.  The  annual 
average  revenue  of  this  monopol}'-,  or  "  Revenue-Farms,"  as  they  are  called,  for 
ten  years  past,  has  amounted  to  4822/.  sterling.  But  the  quantity  of  opium 
smuggled  is  immense  and  incalculable.  Benares  opium  is  that  chiefly  used  by 
the  farmer  for  the  preparation  of  "chandoo"  (the  composition  smoked),  on  ac- 
count of  its  weight  and  cheapness;  but  the  consumers  prefer  the  Patna  opium, 
because  it  has  a  finer  flavour,  is  stronger,  and  its  effects  more  lasting. 

The  following  is  part  of  the  mode  of  preparing  the  chandoo.  Two  balls  are 
as  much  as  one  man  can  properly  prepare  at  once.  The  soft  inside  part  of  the 
opium-ball  is  scooped  out,  and  the  rind  is  boiled  in  soft  water,  and  strained, 
through  a  piece  of  calico.  The  liquor  is  evaporated  in  a  wide  vessel,  and  all 
impurities  carefully  skimmed  off,  as  they  rise  to  the  surface.  The  same  process 
is  gone  through  with  the  soft  opium  extracted  from  the  ball;  and  all  being  mixed 
and  evaporated  to  the  consistence  of  dough,  it  is  spread  out  into  thin  plates,  and 
No.  VII.— -July,  1842.  20 


230  Progress  of  the  Medical  Sciences,  [July 

when  cold,  it  is  cut  into  a  number  of  long  narrow  slips.  These  are  again  reduced 
to  powder,  redissolved,  again  evaporated,  and  ultimately  rolled  up  into  balls, 
and  a  good  deal  resemble  shoemaker's  wax.  In  this  state  it  is  fit  for  smoking, 
and  is  at  least  twice  the  strength  of  crude  opium.  The  Chandoo,  when  once 
smoked,  does  not  entirely  lose  its  powers,  but  is  collected  from  the  head  of  the 
pipe,  and  is  then  called  "  Tye-chandoo,"  or  fsecal  opium,  which  is  made  into' 
pills,  and  swallowed  by  those  whose  poverty  prevents  them  from  smoking  the 
Chandoo  itself. 

In  Penang,  the  opium-smokers  are  the  Chinese,  the  Malays,  and  a  very  few 
of  other  nations,  chiefly  the  native  Portuguese.  It  is  calculated  that  10  per  cent, 
of  the  Chinese,  2|  of  the  Malays,  and  about  1  per  cent,  of  other  natives,  are  ad- 
dicted to  the  vice  of  opium-smoking.  The  poorer  classes  smoke  in  the  shops 
erected  for  that  purpose,  but  the  wealthier  orders  smoke  privately  in  their  own 
houses.  The  practice  is  almost  entirely  confined  to  the  male  sex,  a  few  aban- 
doned prostitutes  of  the  other  sex  partaking  of  the  vice.  A  young  beginner  will 
not  be  able  to  smoke  more  than  five  or  six  grains  of  chandoo,  while  the  old 
practitioners  will  consume  290  grains  daily!  I 

The  causes  which  lead  to  this  dreadful  habit  among  the  Chinese  are, — First, 
their  remarkably  social  and  luxurious  disposition.  In  China,  every  person  in 
easy  circumstances,  has  a  saloon  in  his  house,  elegantly  fitted  up,  to  receive  his 
friends,  with  pipes,  chandoo,  &c.  Ail  are  invited  to  smoke,  and  many  are  thus 
induced  to  commence  the  practice  from  curiosity  or  politeness,  though  few  of 
them  are  ever  able  to  discontinue  the  vice  afterwards. 

Parents  are  in  the  habit  of  granting  this  indulgence  to  their  children,  appa- 
rently to  prevent  them  from  running  into  other  vices  still  more  detestable,  and  to 
which  the  Chinese  are  more  prone  than,  perhaps,  any  people  on  earth.  There 
is  another  cause  which  leads  great  numbers  of  young  men  into  the  practice  of 
opium-smoking,  a  belief,  founded,  it  is  said,  on  experience,  that  the  said  prac- 
tice heightens  and  prolongs  venereal  pleasures.  It  is,  however,  admitted  by 
all,  that  opium-smokers  become  impotent  at  a  much  earlier  period  of  life  than 
others.  In  painful  or  incurable  diseases,  in  all  kinds  of  mental  or  corporeal  suf- 
ferings, in  mercantile  misfortunes,  and  in  other  reverses  of  fortune,  the  opium- 
shop  is  resorted  to  as  an  asylum,  where,  for  a  time  at  least,  the  unfortunate  may 
drown  the  recollection  of  his  cares  and  troubles  in  an  indescribably  pleasurable 
feeling  of  indifference  to  all  around.  The  Malays  are  confident  that  opium- 
smoking  inspires  them  with  preternatural  courage  and  bodily  strength;  it  is, 
therefore,  resorted  to  whenever  any  desperate  act  is  in  contemplation. 

The  smoking-shops  are  the  most  miserable  and  wretched  places  imaginable: 
they  are  kept  open  from  six  in  the  morning  till  ten  o'clock  at  night,  each  being 
furnished  with  from  four  to  eight  bedsteads,  constructed  of  bamboo-spars,  and 
covered  with  dirty  mats  and  rattans.  At  the  head  of  each  there  is  placed  a 
narrow  wooden  stool,  which  serves  as  a  pillow  or  bolster;  and  in  the  centre  of 
each  shop  there  is  a  small  lamp,  which,  while  serving  to  light  the  pipes,  diffuses 
a  cheerless  light  through  the  gloomy  abode  of  vice  and  misery.  On  an  old  table 
are  placed  a  few  cups  and  a  tea-kettle,  together  with  a  jug  of  water,  for  the  use 
of  the  smokers.  At  one  side  of  the  door  the  sub-farmer,  or  cabaret-keeper,  sits, 
with  chandoo,  pipes,  &c.,  for  the  accommodation  of  his  customers.  The  place 
is  filled  with  the  smoke  of  the  chandoo,  and  with  a  variety  of  other  vapours, 
most  intolerable  to  the  olfactories  of  an  European.  The  pipe,  as  may  be  seen, 
is  composed  of  a  shank  and  a  head-piece,  the  former  made  of  hard  and  heavy 
w^ood,  fourteen  inches  long  by  three  inches  and  a  half  in  circumference.  It  is 
bored  through  the  centre,  from  the  mouth-piece  to  the  head,  where  there  is  a 
kind  of  cup  to  collect  the  "  tye-chandoo." 

The  smokers  generally  go  in  pairs,  and  recline  on  the  bedstead,  with  head  rest- 
ing on  the  wooden  stool.  The  mode  of  proceeding  is  as  follows: — First,  one  of 
the  pair  takes  up  a  piece  of  chandoo  on  the  point  of  a  short  iron  needle,  and 
lighting  it  at  the  lamp,  applies  it  to  the  small  aperture  (resembling  the  touch-hole 
of  a  gun),  in  the  head  of  the  pipe.  After  a  few  whiffs  he  hands  the  pipe  to  his 
friend,  who  lights  another  piece  of  chandoo  at  the  lamp;  and  thus  they  go  on 


1842.]  Miscellaneous.  231 

alternately  smoking-  till  they  have  had  sufficient,  or  until  they  are  unable  to  pur- 
chase any  more  of  the  intoxicating  dru^.  The  fume  is  always  expelled  through 
the  nose,  and  old  stagers  even  draw  it  into  their  lungs  before  it  is  expired. 

During  this  time,  they  are  at  first  loquacious,  and  the  conversation  highly  ani- 
mated; but,  as  the  opium  takes  effect,  the  conversation  droops,  and  they  fre- 
quently burst  out  into  loud  laughter,  from  the  most  trifling  causes,  or  without 
any  apparent  cause  at  all,  unless  it  be  from  the  train  of  thoughts  passing  through, 
their  excited  imaginations.  The  next  phase  presents  a  vacancy  of  countenance, 
with  pallor,  and  shrinking  of  the  features,  so  that  they  resemble  people  conva- 
lescing from  a  fever.  A  dead  silence  precedes  a  deep  sleep,  which  continues 
from  half  an  hour  to  three  or  four  hours.  In  this  state  the  pulse  becomes  much 
slower,  softer,  and  smaller  than  before  the  debauch.  Such  is  the  general  pro- 
cess almost  invariably  observed  among  the  Chinese;  but  with  the  Malays  it  is 
often  very  different.  Instead  of  the  placidity  that  ushers  in  the  profound  sleep, 
the  Malays  frequently  become  outrageously  violent  and  quarrelsome,  and  lives 
are  occasionally  lost  in  these  frightful  orgies! 

The  chandoo  is  sometimes  employed  for  the  purpose  of  self-destruction;  but 
from  its  strong  smell  and  taste,  it  is  never  used  as  poison  for  others.  It  does 
not  appear  that  sudden  death  is  ever  produced  by  an  overdose  of  chandoo  when 
used  in  smoking.  When  an  inordinate  quantity  has  been  expended  in  this  way, 
headache,  vertigo,  and  nausea  are  the  effects,  and  are  only  relieved  by  vomiting. 

When  a  person  has  once  contracted  the  habit  of  opium-smoking,  he  finds  it 
extremely  difficult  to  discontinue  the  vice;  yet  there  are  many  instances  of  its 
being  conquered  by  resolution  of  mind.  In  such  attempts  it  is  most  dangerous 
to  approach  the  opium-shops,  as  the  smell  of  the  chandoo  produces  an  irresistible 
desire  to  indulge  once  more  in  the  pernicious  habit;  neither  can  opium-smoking 
be  suddenly  abandoned  without  some  substitute,  as  the  most  serious  or  even 
fatal  consequences  would  ensue.  The  best  substitute  is  a  tincture  of  the  "  tye- 
chandoo"  (which  is  about  one-fourth  the  strength  of  the  "  chandoo"  itself), 
made  with  samsoo,  a  spirit  made  from  rice,  and  taken  in  gradually  diminished 
doses,  till  the  habit  is  broken. 

By  a  continuance  in  this  destructive  practice,  the  physical  constitution  and  the 
moral  character  of  the  individual  are  deteriorated  or  destroyed,  especially  among 
the  lower  classes,  who  are  impelled  to  the  commission  of  crimes,  in  order  to 
obtain  the  means  of  indulging  in  their  dominant  vice. 

The  hospitals  and  poor-houses  are  chiefly  filled  with  opium-smokers.  In  one 
that  I  had  charge  of  the  inmates  averaged  sixt)'^  daily,  five-sixths  of  whom  were 
smokers  of  chandoo.  The  baneful  effects  of  this  habit  on  the  human  constitu- 
tion are  conspicuously  displayed  by  stupor,  forgetful ness,  general  deterioration 
of  all  the  mental  faculties,  emaciation,  debility,  sallow  complexion,  lividity  of 
lips  and  eyelids,  languor  and  lack-lustre  of  eye,  appetite  either  destroyed  or  de- 
praved, sweetmeats  or  sugar-cane  being  the  articles  that  are  most  relished.  In 
the  morning  these  creatures  have  a  most  wretched  appearance,  evincing  no  symp- 
toms of  being  refreshed  or  invigorated  by  sleep,  however  profound.  There  is  a 
remarkable  dryness  or  burning  in  the  throat,  which  urges  them  to  repeat  the 
opium-smoking.  If  the  dose  be  not  taken  at  the  usual  time,  there  is  great  pros- 
tration, vertigo,  torpor,  discharge  of  water  from  the  eyes,  and  in  some  an  invo- 
luntary discharge  of  semen,  even  w^hen  wide  awake.  If  the  privation  be 
complete,  a  still  more  formidable  train  of  phenomena  take  place.  Coldness  is 
felt  over  the  whole  body,  with  aching  pains  in  all  parts.  Diarrhoea  occurs — the 
most  horrid  feelings  of  wretchedness  come  on;  and  if  the  poison  be  withheld, 
death  terminates  the  victim's  existence. 

It  is  generally  remarked,  as  might,  a  priori  be  expected,  that  the  offspring  of 
opium-smokers  are  weak,  stunted,  and  decrepit.  It  does  not  appear,  however, 
that  the  Chinese,  in  easy  circumstances,  and  who  have  the  comforts  of  life  about 
them,  are  materially  affected,  in  respect  to  longevity,  by  the  private  addiction  to 
this  vice,  so  destructive  to  those  who  live  in  poverty  and  distress.  There  are 
many  persons  within  the  sphere  of  my  own  observation,  who  have  attained  the 
age  of  sixty,  seventy,  and  more,  and  who  are  well  known  as  habitual  opium- 


232  Progress  of  the  Medical  Sciences.  [July 

smokers  for  more  than  thirty  years  past.  It  is  a  well-known  fact,  that  the  pre- 
sent Emperor  of  Cliina  was  a  slave  to  the  pernicious  habit  of  smoking  opium  for 
many  years;  but  that,  by  great  moral  courage  and  perseverance,  he  weaned 
himself  from  the  vice,  and  has  ever  since  become  a  most  violent  persecutor  of 
those  who  are  addicted  to  the  indulgence.  He  accordingly  issued  edicts  of 
severe  punishment  against  the  smoker,  vendor,  importer,  and  all  concerned  in 
the  traffic  of  opium;  and,  finding  these  ineffectual,  he  made  the  crime  capital, 
and  punished  it  with  death.  Whatever  may  be  said  in  favour  of  the  opium 
traders,  and  against  the  policy  or  justice  of  the  Chinese  emperor,  I  am  convinced 
in  my  own  mind  that  the  real  object  of  his  edicts  was  the  good  of  his  subjects, 
and  that  he  hoped,  however  vainly,  to  eradicate  a  vice  destructive  alike  of  the 
health  and  morality  of  those  who  become  its  victims.  But  his  majesty's  govern- 
ment acted  on  very  different  principles;  namely,  the  most  selfish,  venal,  and 
mercenary.  It  is  a  notorious  fact,  that  many,  perhaps  most  of  the  officers,  em- 
ployed in  preventing  the  importation  and  smuggling  of  opium,  are  themselves 
opium-eaters,  or  opium-smokers,  and  consequently  that  they  wink  at  the  illicit 
trade,  or  take  bribes  of  opium  or  dollars  for  the  introduction  of  the  drug.  It  is 
well  known  now,  that  in  several  of  the  southern  provinces  of  China,  opium  is 
cultivated  to  a  great  extent,  without  any  check  from  the  local  authorities,  and, 
doubtless,  without  any  knowledge  of  the  emperor  himself.  The  propensity  to 
opium-smoking  is  becoming  so  universal  and  so  irresistible  in  China,  that  no 
sumptuary  laws,  however  sanguinary,  will  be  able  to  stem  the  torrent.  In 
Penang  excessive  duties  have  only  increased  the  thirst  for  opium,  and  vi-'hat  is 
worse,  they  have  quadrupled  the  number  of  murders  and  other  crimes  committed 
in  order  to  obtain  the  means  of  procuring  the  drug! ! 

Pulo  Penang,  Straits  of  Malacca. 

Note  hy  Dr.  Johnson. — The  foregoing  paper  has  been  laid  before  the  society, 
partly  because  the  subject  is  curious,  and  little  known  in  this  country,  but  chiefly 
for  the  purpose  of  offering  one  or  two  practical  snggestions  to  the  members. 

First,  1  think  it  will  be  admitted  that  the  Chinese  mode  of  taking  opium 
by  smoking  or  inhalation,  induces  the  peculiar  sedative  effects  of  that  drug  more 
powerfully  and  more  speedily  than  when  taken  into  the  stomach. 

Second,  There  can  I  believe,  be  little  doubt,  that  these  effects  are  produced 
chiefly,  if  not  entirely  through  the  medium  of  the  nervous  system,  and  not  by 
digestion,  absorption,  and  the  circulation. 

Third,  It  does  not  appear  that  the  casual  or  temporary  smoking  of  opium  is 
more  dangerous  or  injurious  to  the  constitution  than  that  of  swallowing  the  drug, 
whether  in  substance  or  solution.  On  the  contrary,  I  believe  it  is  less  so,  and  not 
so  likely  to  impair  the  functions  of  the  stomach,  liver,  and  bowels,  as  when  di- 
rectly applied  to  the  digestive  apparatus. 

Fourth,  The  habitual  abuse  of  a  drug,  by  which,  in  fact,  it  is  converted  into  a 
poison,  is  no  argument  or  reason  against  its  occasional  exhibition  as  a  remedial 
agent. 

Fifth.  If  the  above  observations  be  admitted  as  rational,  I  see  no  reason  why 
we  should  not  employ  the  Chinese  mode  of  inhaling  the  fumes  of  opium,  in 
certain  dangerous  and  painful  maladies  where  the  common  mode  is  found  to  be 
inefficient,  and  attended  with  great  derangement  of  the  digestive  organs.  It  is 
clear  that  we  can  very  seldom  induce  that  profound  sleep  and  insensibility  to  all 
mental  misery  and  corporeal  pain,  by  opium  taken  into  the  stomach,  which  we 
find  to  be  produced  by  the  inhalation  of  its  fumes  acting  directly  on  the  brain, 
through  the  medium  of  the  nerves.  Might  not  the  Chinese  mode,  then,  be 
adopted  in  tetanus,  hydrophobia,  tic-douloureux  (especially  of  the  facial  nerves), 
violent  spasms,  and  painful  diseases  that  defy  the  power  of  opium  taken  in  the 
common  way?* 

*  This  idea  has  been  acted  on  in  France  for  several  years.  The  cigars,  which  are 
made  for  this  purpose,  have  also  been  imported  into  this  country,  and  we  have  used 
them  in  several  cases  of  tic  douloureux,  and  sometimes  have  found  them  to  afford  great 
relief  to  the  patient. — Ed. 


1842.]  Miscellaneous.  233 

The  various  preparations  of  opium  might  be  easily  smoked  by  means  of  a 
common  pipe,  and  the  powerful  effects  induced  in  a  very  short  space  of  time, 
without  the  possibility  of  their  being  rejected  by  the  stomach,  or  prevented 
from  acting  energetically  on  the  sensorium,  and  throughout  the  whole  nervous 
system. — Med.  Chirurg.  Rev.  April,  1842. 

102.  The  Bavarian  Schools  of  Medicine  suspended. — The  Home  Secretary  of 
State  in  Bavaria  has  recently  forwarded  an  ordinance  to  the  three  universities 
of  that  kingdom,  enjoining  them  to  close  all  the  schools  of  medicine.  The  mo- 
tives of  this  injunction  are  stated  to  be  the  fact  that  more  medical  men  exist 
than  can  find  occupation,  and  there  are  700  applications  to  the  minister  from, 
young  medical  men  who  seek  employment. 

103.  Desertion  of  children  in  France. — MM.  Terme  and  Monfalcon  state  that 
in  large  manufacturing  districts,  and  among  artisans,  the  parents  separate 
themselves  from  their  children,  with  a  most  lamentable  carelessness,  and  look 
on  it  as  infinitely  more  convenient  and  desirable  to  take  their  children  to  a 
hospice,  and  to  forget  them,  than  to  trouble  themselves  about  bringing  them  up. 
M.  Lelong,  a  member  of  the  general  council  of  the  Seine  Inferieure,  states  that 
in  some  neighbourhoods  the  number  of  foundlings  has  equalled,  and  sometimes 
even  exceeded,  the  number  of  children  born  out  of  wedlock.  At  the  Hotel- 
Dieu,  at  Lyons,  there  is  a  lying-in  ward  for  the  wives  of  the  artisans,  in  which 
from  500  to  600  are  delivered  annually.  More  than  60  of  these  women  are  de- 
tected every  year  by  the  vigilance  of  the  police,  in  their  attempt  to  send  their 
children  to  the  hospice,  and  are  compelled  to  take  them  back  again.  Many 
elude  the  officers,  and  succeed  in  getting  rid  of  their  children.  2,000  are  ad- 
mitted every  year  into  the  foundling  hospital  at  Lyons,  and  of  these  400  are 
considered  to  be  legitimate.  During  the  twenty  years  from  1816  to  1835,  57,400 
women  have  been  delivered  in  the  Maternite,  at  Paris,  and  19-20ths  of  them 
sent  their  children  to  the  Hospice  des  Enfans  trouves. — B.  and  F.  Med.  Rev, 
April,  1842. 

104.  University  College,  London. — Dr.  Murphy,  late  assistant  physician  to  the 
lying-in  hospital,  Dublin,  has  been  elected  to  the  professorship  of  Midwifery  in 
this  Institution,  in  the  place  of  Dr.  Davis  recently  deceased. 

105.  Obituary  Record. — We  greatly  regret  to  have  to  record  the  death  of  Sir 
Charles  Bell,  which  took  place  suddenly  on  the  morning  of  the  29lh  ult.,  at 
Hallow  Park,  near  Worcester,  the  residence  of  Mrs.  Holland,  whom  the  de- 
ceased and  Lady  Bell  were  visiting  on  their  way  to  Malvern. 

Sir  Charles  had  been  subject  to  pains  about  the  chest  of  a  spasmodic  nature, 
and  latterly  assuming  the  characters  of  angina  pectoris.  He  had  been  very 
unwell  at  Manchester  a  short  time  before,  and  had  suffered  much  from  pains  in 
the  stomach  during  his  visits  at  Hallow;  but  appeared  quite  as  well  as  usual  on 
the  28th,  and  had  been  out  for  a  considerable  time  during  the  day.  At  night  the 
pains  again  became  severe,  but  no  danger  was  apprehended  until  8  o'clock  on 
the  morning  of  the  29th,  when  he  became  rather  suddenly  very  quiet,  and  Lady 
Bell,  greatly  alarmed,  sent  for  Dr.  Carden,  of  Worcester,  who,  on  his  arrival, 
found  him  quite  dead,  with  the  appearance  of  life  having  been  for  some  time 
extinct. 

Sir  Charles  was  67  years  of  age,  and,  with  the  exception  of  the  complaint 
which  proved  fatal,  retained  considerable  vigour  and  activity.  He  was  out 
sketching  on  the  28th,  being  particularly  pleased  with  the  village  church,  and 
some  fine  trees  which  are  beside  it;  observing,  that  he  should  like  to  repose 
there  when  he  was  gone.  On  Monday  last,  being  just  four  days  after  this  senti- 
ment had  been  expressed,  his  mortal  remains  were  accordingly  deposited  beside 
the  rustic  graves  which  had  attracted  his  notice,  and  so  recently  occupied  his 
pencil.— Lonrf.  Med.  Gaz.  May  1842. 

We  notice  with  regret  the  death  of  the  venerable  Dr.  Yelloly,  which  took 

20* 


234  Progress  of  the  Medical  Sciences,  [My 

place  on  Tuesday,  the  1st  of  February.  Dr.  Yelloly  commenced  public  life  as 
physician  to  the  London  Hospital,  and  lecturer  on  the  practice  of  physic.  He 
was  one  of  the  founders  of  the  Medico-Chirurgical  Society,  one  of  its  most 
zealous  supporters,  and  contributed  many  papers  to  its  transactions.  About 
twenty  years  ago  Dr.  Yelloly  removed  from  London  to  Norwich,  and  was  sub- 
sequently appointed  physician  to  the  Norfolk  and  Norwich  Hospital;  here  he 
devoted  much  of  his  attention,  in  conjunction  with  his  colleague,  Mr.  Crosse,  to 
the  subject  of  urinary  calculi.  In  one  of  the  volumes  of  the  "  Philosophical 
Transactions"  he  published  a  valuable  analysis  of  the  unrivalled  Norwich  col- 
lection. Few  men  possessed  a  finer  philosophical  taste  than  Dr.  Yelloly,  and 
no  one  ever  continued  the  pursuit  of  medical  science,  for  its  own  sake,  more 
uniformly  during  a  long  life.  Dr.  Yelloly  enjoyed  the  friendship  of  Dr.  Marcet, 
Dr.  Roget,  and  many  other  eminent  men  in  the  profession,  and  had  gained  the 
respect  of  an  extensive  circle  of  acquaintances.  He  was  a  man,  excellent  in 
public  and  private  life. — Prov.  Med.  and  Surg.  Journ.  Feb.  1842. 

Died  at  Berlin  in  Jan.  1842,  Dr.  E.  Osann,  President  of  the  Medico-Chirur- 
gical Society  of  Berlin  and  editor  of  the  Journal  of  Practical  Medicine. 

at  Paris  March  13,  1842,  M.  Divergie,  author  of  a  valuable  work  on  the 

Venereal  disease. 

at  Hamburgh  J.  C.  G.  Fricke,  M.  D.,  Surgeon  to  the  Hamburgh  Hospi- 
tal, and  one  of  the  editors  of  the  Zeitschrift  fiir  die  gesammte  Medicin,  &c. 

May  9th,  at  Hyeres  near  Toulon,  Dr.  Andrew  Blake,  a  native  of  Dublin, 

well  known  in  this  country  as  the  author  of  a  work  on  delirium  tremens. 


1842.]  335 


AMERICAN  INTELLIGENCE. 


Expulsion  of  a  mass  of  hair  from  the  Uterus.  By  Henry  R.  Frost, 
M.D.,  Charleston,  South  Carolina. — To  give  full  interest  to  the  above  ex» 
traordinary  occurrence,  it  is  necessary  to  detail  the  circumstances  connect- 
ed with  a  case  of  tedious  and  instrumental  labour. 

A  coloured  girl  aged  25  years,  pregnant  with  her  first  child,  was  taken 
with  the  pains  of  labour,  about  6  o'clock  on  the  evening  of  the  9lh  of  Sep- 
tember, 1838.  The  habit  of  the  patient  was  strong,  and  her  health  good. 
There  was  no  occurrence  during  the  first  twenty-four  hours  to  excite  un- 
easiness, but  the  delay  which  occasioned  the  accoucheuse  to  suppose  that 
there  was  something  wrong. 

On  the  evening  of  the  10th,  I  was  called  to  see  her.  Upon  examina- 
tion, I  discovered  nothing  at  fault,  but  the  slowness  of  dilatation  in  the  os 
uteri.  There  appeared  to  be  some  thickening  of  its  orifice.  The  liquor 
amnii  was  passing  off  slowly,  the  hairy  scalp  could  be  felt  protruding,  and 
the  vertex  resting  upon  the  brim  of  the  pelvis.  To  favour  relaxation,  a 
dose  of  castor  oil  had  been  administered  in  the  morning,  and  a  small  quan- 
tity of  blood  taken  from  the  arm.  Expecting  that  the  pains  would  be 
renewed,  and  finding  nothing  requiring  my  assistance,  left  the  patient  in 
the  charge  of  the  midwife. 

Sept.  nth. — This  morning  at  9  o'clock,  find  upon  examination,  that 
the  vertex  had  made  little  progress;  the  os  uteri  being  a  little  dilated,  and 
thinner;  repeated  the  venesection. 

1  o'clock. — But  little  progress  made,  and  as  the  pains  were  exhausting 
without  producing  much  effect,  recommended  that  they  be  allayed  as  much 
as  possible;  directed  acetate  of  morphia  in  doses  of  J-  of  a  grain  every  half 
hour  until  easier. 

7  o'clock. — The  medicine  had  been  taken,  and  some  relief  experienced. 

I2th. — The  pains  were  removed  during  the  night,  but  with  litile  bene- 
fit. Upon  examination,  but  little  change  was  perceptible;  the  head  had 
descended  a  little  lower,  and  the  protruding  scalp  filled  up  the  os  uteri. 
Apprehending  that  there  might  be  some  obstruction  to  the  passage  of  the 
head,  and  that  difficulty  would  occur  in  the  course  of  the  labour,  request- 
ed assistance. 

The  late  Professor  Wagner  was  called,  and  upon  examination,  the 
patient  concurred  in  the  opinion  I  had  formed  of  the  presentation;  recom- 
mended patience  and  perseverance.  The  powers  of  the  patient  were 
good,  and  as  the  pulse  was  more  active  than  proper,  further  venesection 
was  recommended. 

The  condition  of  the  patient  was  little  altered  during  the  day  and  night. 

I3th. — Still  trusting  to  nature,  and  nothing  done  to  expedite  delivery. 
At  8  o'clock,  P.  M.  the  forceps  were  applied,  but  with  no  advantage.  In 
the  course  of  the  night,  the  ergot  in  infusion  was  freely  administered,  but 
without  any  effect. 


236  American  Intelligence,  [July 

During  the  day  a  discharge  of  meconium  in  considerable  quantity  was 
noticed,  an  occurrence  in  a  presentation  of  the  vertex  very  unusual. 

In  the  progress  of  the  labour,  it  became  necessary  to  draw  off  the  urine 
twice  a  day,  but  it  is  somewhat  singular,  that  though  tiie  catheter  was  in- 
troduced, a  very  small  quantity  of  urine  was  removed,  while  a  tumour 
which  was  formed  by  the  distended  bladder  could  not  be  reduced,  though 
pressure  was  made  upon  it. 

lUh. — At  9  o'clock  A.  M.  the  head  was  perforated,  and  the  child  ex- 
tracted. The  operation  was  completed  in  about  half  an  hour,  and  was 
well  supported  by  the  patient.  The  placenta  was  extracted,  and  the 
patient  made  as  comfortable  as  possible;  some  soreness  and  tumefaction 
was  experienced,  and  at  night  nearly  two  quarts  of  urine  were  removed. 

Ibth^  I6th,  11  th. — The  patient  continues  to  improve. 

Now  17 th. — The  progress  of  the  patient  was  a  very  slow,  but  gra- 
dual amendment.  About  this  period;  she  complained  of  fever,  which 
continued  at  variable  periods  during  the  day,  followed  by  very  profuse  per- 
spiration. There  was  considerable  discharge  from  the  vagina  of  a  puri- 
form  and  very  offensive  fluid,  pains  about  the  region  of  the  pubes  at 
times  considerable,  occasionally  tumefaction  of  the  abdomen,  the  appetite 
variable.  To  relieve  some  of  these  symptoms,  general  treatment  was 
adopted,  and  the  use  of  an  astringent  injection. 

19th. — The  patient  informed  me  that  the  vagina  was  filled  with  a  sub- 
stance, which  prevented  the  introduction  of  the  syringe,  that  sitting  was 
very  uncomfortable,  and  the  feeling  of  something  which  was  to  be  re- 
moved. 

Upon  examination,  I  discovered  a  substance  of  a  dark  colour,  present- 
ing at  the  OS  externum.  I  provided  myself  with  a  pair  of  forceps,  and 
with  little  trouble  extracted  a  mass,  several  inches  in  length,  (say  5  inches) 
and  an  inch  and  a  half  in  diameter,  at  its  largest  part,  looking  like  wet 
tow,  of  an  irregular  and  somewhat  pear-like  shape.  Carefully  inspecting  it, 
it  proved  to  be  a  mass  of  hair,  in  short  pieces,  of  an  inch  to  two  inches  in 
length,  very  offensive,  and  saturated  with  a  purulent  looking  fluid.  The 
symptoms  above  noticed,  soon  subsided,  and  the  person  recovered  in  a  con- 
siderable degree.  The  preparation  is  now  to  be  seen  in  the  museum  of 
the  Medical  College  of  the  state  of  South  Carolina. 

The  preceding  occurrence  affords  a  subject  for  speculation  and  inquiry. 

It  could  not  have  been  an  offcast  from  the  first  child,  the  quantity  of  hair 
being  too  considerable,  and  of  a  different  texture  from  what  is  usually  found 
on  a  coloured  child. 

It  must  have  existed  in  the  uterus  at  the  time  the  first  child  was  born, 
and  must  have  remained  in  the  cavity  of  this  organ,  and  the  vagina,  nearly 
two  months  after  the  delivery.  This  is  more  remarkable,  inasmuch  as 
the  placenta  was  removed  after  the  birth  of  the  child,  and  the  condition  of 
the  uterus  carefully  examined. 

When  removed,  it  had  no  appearance  of  being  enveloped  with  mem- 
branes. 

Was  it  an  abortive  effort  of  nature  in  the  production  of  twins?  or  was 
it  of  that  class  of  morbid  growths,  which  are  so  frequenfly  formed  in  the 
ovaria? 

Case  of  expulsion  of  the  Foetus  about  the  sixth  month  ivith  the  mem- 
branes entire.    By  Robert  S.  Bailey,  M.D.,  Charleston,  South  Carolina. 


1842.]  .  American  Intelligence.  237 

—Mrs.  D.  arrived  from  the  country  about  the  1 5th  of  June,  1821,  affected 
with  fever  which  afterwards  assumed  an  intermittent  character.  She  in- 
formed me,  that  she  supposed  herself  to  be  between  the  fifth  and  sixth 
months  of  utero-gestation.  I  was  apprehensive  from  the  first,  that  abor- 
tion would  take  place,  but  endeavoured  to  prevent,  as  far  as  possible,  such 
an  occurrence  by  the  ordinary  means  employed  in  such  cases,  as  bleeding, 
anodynes,  <fec. 

July  Itli.' — On  visiting  her,  I  was  informed  that  she  experienced 
some  uneasiness  last  night,  and  took  an  anodyne  draught  which  had 
been  left  for  the  ague;  rested  during  the  night;  arose  and  the  pains  re- 
turned with  violence  this  morning.  I  administered  tinct.  opii,  gtt.  xxv,  but 
without  any  effect  in  relieving  the  pain.  The  progress  of  the  labour 
now  become  quick,  the  pain  constant,  a  slight  discharge  of  water,  and  the 
ovum  was  expelled  immediately  afterwards  entire.  Such  an  uncommon 
appearance  surprised  me;  I  did  not  measure  it,  which  I  afterwards  regret- 
ted, but  suppose  it  was  about  18  inches  in  length,  and  9  in  breadth.  The 
membranes  being  semi-pellucid,  I  observed  the  child  to  open  its  eyes.  I 
therefore  made  an  opening  with  a  pair  of  scissors,  and  placed  the  child 
attached  to  the  placenta,  in  warm  water;  it  was  curious  to  observe  the  ef- 
fect, the  vital  powers  of  the  child  appearing  to  increase  as  the  stimulus  of 
heat  was  applied,  and  vice  versa,  giving  a  full  demonstration  of  the  beau- 
tiful theory  of  the  celebrated  Dr.  Brown,  that  "  life  is  a  forced  state."  After 
continuing  the  immersion  about  two  hours,  the  child  respired  perfectly,  and 
cried  with  some  strength;  it  was  then  separated,  and  lived  about  twelve 
hours,  and  might  probably  with  care,  have  continued  to  live.  The  matrons 
of  the  family,  however,  (an  authority  we  can  seldom  dispute,)  concluding 
it  to  be  impossible,  and  the  mother  having  a  numerous  offspring,  indiffer- 
ence was  manifested,  as  to  the  use  of  means.  The  lady  recovered  in  a 
short  time  without  any  unfavourable  symptoms  taking  place.  Cases  of  this 
description  may  not  be  uncommon,  yet  I  do  not  remember  to  have  seen 
any  described  by  obstetric  authors  under  such  circumstances,  and  for  that 
reason,  now  lay  it  before  the  profession. 

[Expulsion  of  the  foetus,  at  a  late  period  of  utero-gestation  with  the 
membranes  unbroken,  is  of  rare  occurrence,  but  examples  of  it  have  been 
before  recorded.  Dr.  D.  Humphreys  Storer,  of  Boston,  in  the  first  num- 
ber of  our  cotemporary,  the  Neiv  England  Quarterly  Journal  of  Med. 
and  Surg.,  states  that  **  in  August  1833,  a  lady  was  delivered  at  her  full 
time  of  her  first  child,  a  boy,  enveloped  in  the  membranes  entire — much 
to  the  amazement  of  the  nurse  and  her  friends."  He  further  states  that  in 
April  of  the  following  year  he  met  with  another  case,  where  the  woman 
had  advanced  but  seven  and  a  half  months  in  her  pregnancy.  He  could 
not,  in  this  case,  break  the  membranes,  but  was  obliged  to  cut  them,  to  re- 
lease the  child,  which  was  alive  and  active.— Editor. 1^ 

Statistics  of  the  Medical  Colleges  in  the  United  States,  continued 
from  Vol.  I,  New  Series,  p.  266.~In  1840,  a  new  Medical  School  was 
organized  at  St.  Louis  (Missouri),  being  a  Department  of  Kemper  College, 
In  1841  the  Medical  Department  of  the  University  of  the  City  of  Nev^ 
York  was  organized. 


238 


Ainerican  Intelligence, 


[July 


Colleges. 


1840-41. 

No.  attend-    Of  whom   No.  deduct- 
ing Lee-     were  Phy-     ing  Phy- 
tures  6icians         eicians 


1.  Bowdoin  62 

2.  Dartmouth  (1841)      80 

3.  Castleton  54 

4.  Harvard  88 

5.  Berkshire,  autumn,   74 

6.  Yale  52 

7.  New  York  Col.  of 
Phy.  and  Surg-. 

8.  Univ.  City  N.  Y 

9.  Albany 

10.  Geneva 

11.  Univ.  of  Penn. 

12.  Jefferson  Med.  Col.  163 

13.  Med.  Col.  State  of 
South  Carolina 

14.  Transylvania  Univ.  254 

15.  Louisville  Med. 

Institute  205 

16.  Willoughby  Coll. 

17.  Med.  Col.  of  La.       27 

18.  Kemper  College, 

St.  Louis      40 

19.  Med.  Coll.  of  Ohio 

20.  Richmond  Med.  Col.  55 


101 

123 

136 
410 


10 
12 
53 
23 


21 
26 


100 

113 
124 

357 
140 


233 
179 


1841-42. 

No.  attend-   Of  whom      No.de- 
ing  Lee-     were  Phy-     ducting 
tures  sicians     Physicians 


118 

103 

47 

109 

109 

239 

239 

101 

5 

96 

211 

58 

1.53 

363 

43 

320 

209  . 

42 

167 

158 

271 

28 

243 

262 

26 

236 

57 

3 

54 

152 


1924 


146 


2400        205 


GRADUATES. 

Colleges.  1840-41. 

Dartmouth  13 

Castleton  (1841)  12 

Harvard  16 

Berkshire  20 
Yale 

New  York  Coll.  Phys.  and  Surg.  25 

University,  City  New  York 

Albany  30 

Geneva  36 

University  of  Pennsylvania  166 

Jefferson  Med.  College  57 

Pennsylvania  Med.  College  42 

Med.  College,  South  Carolina  51 

Transylvania  62 

Louisville  48 

Willoughby  7 

Med.  College,  Louisiana  9 
Columbia  College,  D.  C. 


1841-42. 


22 

19 
16 
51 
26 
36 
114 
61 


58 
55 
53 


20 


The  above  are  all  taken  from  official  catalogues  or  Medical  Journals,  except 
of  the  Medical  College  of  Louisiana,  which  were  obtained  from  Prof.  Jones,  by 
J.  S.  Wood,  M.  D.,  of  this  city. 

The  reader  will  perceive  the  incompleteness  of  the  respective  tables,  but  the 
means  of  supplying  this  in  full  are  probably  beyond  the  reach  of  any  single  in- 
dividual. 

I  add  the  following,  as  of  some  interest,  from  the  Foreign  Quarterly  Review 
of  Jan.  1841. 


404 

Jena 

72 

122 

Kenigsberg 

84 

128 

Leipsic 

220 

115 

Munich 

195 

148 

Copenhagen 

142 
T.  R.  B. 

1842.]  American  Intelligence,  239 

Number  of  medical  students  in  the  several  German  Universities  at  the  recent 
conclusion  of  the  academical  year.  The  editors  remark  that  they  have  been  at 
some  pains  to  collect  these  and  other  statistics  of  the  universities. 

Berlin 

Bonn 

Breslau 

Halle 

Heidelbersf 


On  the  Intermittent  Fever  of  New  England.  By  Samuel  Forry,  M.  D.  (Ex- 
tract from  a  letter  to  the  Editor. 

Dear  Sir: — Dr.  Stephen  W.  Williams,  of  Deerfield,  Mass.,  having  contro- 
verted, in  a  communication  lately  made  to  you,  a  statement  of  mine  that  appeared 
in  an  article  on  "The  Endemic  Influences  of  the  United  States,"  published  in 
your  Journal  for  October  last,  it  is  desirable  that  such  an  explanation  may  be 
made  as  will  avoid  all  subsequent  controversy,  whilst  the  ends  of  Medical  Sci- 
ence shall  be  promoted.  Upon  this  point  Dr.  Williams  evinces  the  proper  spirit. 
In  the  investigation  of  a  subject  so  diversified  and  extended  as  the  medical  ge- 
ography of  the  United  States,  it  requires  the  combined  labours  of  all  who  have 
at  heart  the  interest  no  less  of  general  than  of  medical  science.  If  every  one 
would  contribute  his  mite  after  the  manner  of  Dr.  W.,  much  would  soon  be 
effected  towards  determining  the  laws  of  nature  in  regard  to  the  influence  of 
external  agents  upon  the  healthy  and  diseased  condition  of  man. 

The  error  exposed  by  Dr.  W.  is  found  in  the  following  quotation  made  by 
me  from  the  work  of  Dr.  Joseph  Mather  Smith  on  the  etiology  of  epidemics: — 
"  On  the  Connecticut  river,  from  Northampton  in  Massachusetts  to  its  source, 
a  distance  of  more  than  200  miles  north  and  south,  and  on  all  its  tributary 
streams  on  both  sides  for  100  miles  in  width,  there  has  been  no  instance  of  any 
person  having  contracted  the  intermittent  fever,  from  the  first  settlement  of  the 
country  to  the  present  time."  This  statement,  it  seems,  was  first  made  by 
Professor  Nathan  Smith  in  his  work  on  Typhus  Fever,  and  to  show  its  errone- 
ousness.  Dr.  Williams  refers  me  to  Holmes'  Prize  Dissertation  on  the  Intermit- 
tent Fever  of  New  England,— a  work  which  I  take  shame  in  acknowledging 
that  I  have  not  before  read.  Dr.  Holmes,  many  of  whose  facts  were  obtained 
by  opening  a  general  correspondence  by  letter  throughout  New  England,  proves 
conclusively  that  intermitting  fever  has  prevailed  on  the  Connecticut  river  from 
our  earliest  colonial  history.  In  a  letter  from  Dr.  Williams  himself,  contained 
in  this  treatise,  it  is  shown  that  the  locality  of  Deerfield,  on  the  Connecticut, 
which  was  once  the  bed  of  a  lake,  and  subsequently  became  converted  into 
meadows  and  marshes,  was  in  former  years  rife  with  fever  and  ague.  Within 
the  last  sixty -five  years,  however,  few  cases  have  occurred,  and  at  present  it  is 
unknown — a  result  ascribable  to  the  gradual  drying  up  of  the  marshes.  Dr. 
Holmes  further  proves  from  historical  evidence  that,  in  1671,  fever  and  ague 
prevailed  at  Boston,  and  also  at  New  Haven,  on  its  "first  planting."  In  regard 
to  the  latter  place,  the  historian  remarks  that  "  upon  these  southern  coasts  of 
New  England  it  is  not  annual,  as  in  Virginia,  there  being  sundry  years  when 
there  is  nothing  considerable  of  it,  nor  ordinarily  so  violent  and  universal." 

Dr.  Holmes'  essay  is  accompanied  with  a  map  of  New  England,  exhibiting 
the  localities  in  which  intermittents  have  been  at  any  time  indigenous;  and  the 
fact  that  but  twenty-seven  such  points,  including  three  on  Lake  Champlain,  are 
laid  down  over  this  wide  extent  of  territory,  proves  of  itself  the  extreme  infre- 
quency  of  the  disease.  Moreover,  one  half  of  these  localities  are  on  the  Con- 
necticut and  Housatonic  rivers,  which  have  rich  alluvial  tracts,  whilst  along  the 
shore  of  Long  Island  Sound,  between  the  mouths  of  these  two  rivers,  a  narrow 
alluvialjiat  extends.  These  facts,  then,  instead  of  disproving,  confirm  the  con- 
clusion arrived  at  in  my  article  on  "  The  Endemic  Influences  of  the  United 
States,"  viz.  that  a  region  of  primary  formation^  with  a  sandy  soil  and  an  undu- 
lating surface,  is  exem.pt  from  fever  and  ague.  The  occasional  prevalence  of 
this  disease  in  the  valley  of  the  Connecticut  river,  affords,  indeed,  a  happy 


240  American  Intelligence.  [July 

illustration  of  the  ancient  axiom  of  the  exception  proving-  the  rule;  for  here, 
contrary  to  the  general  geological  character  of  New  England,  we  have  a  secon- 
dary instead  of  a  primary  formation.  "The  valley  of  the  Connecticut,"  says 
Bradford  in  his  Illustrated  Atlas,  "is  occupied  by  a  basin  of  secondary  rocks  of 
about  fifteen  miles  in  average  width,  consisting  of  red  shales,  argillaceous 
sandstones,  and  beds  of  conglomerates,  crossed  by  numerous  dykes  and  ridges 
of  trap."  As  this  formation  has  an  alluvial  superstratum,  we  discover  a  marked 
geological  analogy  between  this  valley  and  the  Atlantic  plain  on  which  malarial 
diseases  are  dominant. 

In  my  article  on  "The  Endemic  Influences  of  the  United  States,"  the  follow- 
ing language  is  used: — "  Now  as  the  region  of  New  England,  with  little  excep- 
tion^ has  a  primitive  formation,  with  a  sandy  and  sterile  soil,  whilst  that  of  the 
great  lakes  consists  of  a  secondary  formation,  having  not  unfrequently  an  allu- 
vial superstratum  of  a  rich  vegetable  mould,  from  three  to  six  feet  deep,  it  is 
not  difficult  to  deduce  the  correct  inference.  In  the  former,  the  geological  form- 
ation is  destitute  of  organic  remains,  and  the  little  contained  in  the  sandy  soil 
does  not  find  enough  of  moisture  to  induce  the  necessary  chemical  action; 
whilst  in  the  latter,  not  only  is  the  geological  structure  of  secondary  origin,  but 
the  deep  rich  soil  is  sufficiently  humid,  when  a  high  temperature  acts  upon  the 
organic  remains  with  which  it  abounds,  for  the  development  of  the  morbid 
poison,  called  malaria."  Now  in  adverting  to  the  italicised  words,  '■'■with  little 
exception^''''  does  it  not  afford  a  striking  confirmation  of  the  validity  of  my  de- 
duction, to  find  by  subsequent  facts  that  this  excepted  portion  is  the  one  in  which 
fever  and  ague  have  always  been  more  or  less  generated!  As  this  disease  is 
no  longer  known  at  Boston,  Deerfield,  and  some  of  the  other  localities  laid 
down  on  Holmes'  map,  we  are  warranted  in  the  belief  that  the  endemic, 
wherever  it  may  have  been  indigenous  in  the  New  England  States,  is  attributa- 
ble to  peculiar  local  causes;  as,  for  example,  at  Deerfield  there  formerly  existed 
an  accumulation  of  remains  in  the  marshes  and  meadows  formed  by  the  bed  of 
an  ancient  lake. 

In  my  work  on  "The  Climate  of  the  United  States  and  its  Endemic  Influ- 
ences," which  will  be  published  in  a  few  days,  the  question  of  the  agency  of 
soil  in  the  production  of  malarial  diseases,  is  still  more  fully  investigated. 

I  have  the  honour  to  be,  very  respectfully,  your  obed't.  serv't, 

Samuel  Forry,  M.  D. 

New  York,  March  1,  1842. 

Nathaniel  Chapman^  M.  D. — The  following  sketch  of  the  distinguished  Pro- 
fessor of  the  practice  of  medicine  in  the  University  of  Pennsylvania  is  from  our 
cotemporary  the  Medical  Examiner.  All  who  are  acquainted  with  the  "  present 
head  of  the  profession"*  in  this  country  will  bear  testimony  to  the  correctness 
of  the  outlines  and  the  perfect  justice  of  the  colouring: — 

Professor  Chapman  is  the  Sir  Henry  Halford  of  the  United  States.  He  is 
not  more  distinguished  for  professional  attainments  than  for  courtliness  and 
vivacity  of  manner,  wit,  knowledge  of  the  world,  and  literary  taste.  His  pri- 
vate character  forms  a  marked  contrast  with  that  of  his  late  friend  and  cotempo- 
rary, Physick,  with  whom  he  so  long  shared  the  first  rank  in  the  profession  of 
Philadelphia.  Physick,  who  shunned  general  society,  and  was  little  known 
except  in  professional  intercourse,  had  a  reserved  stateliness  of  manner  from 
which  he  never  unbent.  Engrossed  by  his  patients  and  profession,  he  seldom 
entered  into  the  every-day  topics  of  life,  and  is  remembered  only  as  the  skilful 
surgeon  and  successful  operator.  Chapman's  temperament  was  cast  in  a  differ- 
ent mould.  Eminently  social  in  disposition,  with  a  gaiety  of  spirit  that  has  not 
flagged  with  years— a  wit — a  punster — delightful  as  a  companion,  and  enjoying 

*  He  was  thus  enthusiastically  toasted  at  a  very  large  professional  dinner  in  Phila- 
delphia two  years  since.  The  first  toast  was  "the  memory  of  the  late  head  of  the 
profession,  Dr.  Physick."  On  Dr.  Chapman,  who  presided,  rotiringr,  his  health  as  the 
present  head  of  the  profession  was  offered  as  a  toast,  and  received  with  acclamation. 


1842.]  American  Intelligence.  241 

company,  he  has,  for  a  long  period,  occupied  a  position,  we  may  say  unrivalled, 
in  the  society  of  this  city.  To  these  brilliant  qualities  he  unites  the  kindliest 
feelings.  His  wit  is  without  malice,  and  he  is  frank,  open-hearted,  and  open- 
handed.  It  is  not,  then,  surprising  that  he  is  individually  as  popular  as  he  is 
professionally  eminent. 

Dr.  Chapman  was  born  in  Fairfax  county,  Virginia,  on  the  28th  of  May, 
1780,  and  has  therefore  nearly  completed  his  sixty-second  year.  His  paternal 
ancestor  came  to  Virginia  with  the  first  colony,  was  a  captain  of  cavalry  in  the 
British  army,  and,  according  to  an  authentic  tradition  in  the  family,  was  the 
youngest  son  of  a  cousin-german  of  Sir  Walter  Raleigh.  The  family  settled  on 
the  river  Pomonkey,  some  twenty  miles  from  Richmond,  but  the  branch,  from 
which  the  doctor  is  descended,  migrated  about  a  century  and  a  half  ago  to 
Maryland,  and  fixed  itself  on  an  estate  on  the  banks  of  the  Potomac,  nearly 
opposite  Mount  Vernon,  which  is  still  in  their  possession.  The  doctor's  father, 
however,  went  to  Virginia,  upon  his  marriage,  where  he  afterwards  remained. 

Dr.  Chapman  received  his  early  education  at  the  Classical  Academy  of  Alex- 
andria, D.  C,  founded  by  General  Washington,  where  he  was  six  years.  He 
subsequently  spent  a  short  time  in  two  colleges,  though  not  long  enough  to  owe 
either  any  obligation.  He  came  to  Philadelphia  in  the  autumn  of  1797,  to  com- 
mence the  study  of  medicine  with  the  late  Professor  Rush,  of  whom  he  became 
a  favourite  pupil.  He  continued  three  years  with  Rush,  and  in  attendance  upon 
the  lectures  at  the  University  of  Pennsylvania,  from  which  he  received  his  de- 
gree in  the  spring  of  1800.  The  doctor's  thesis  was  on  hydrophobia,  written, 
we  have  been  told,  at  the  request  of  Dr.  Rush,  in  answer  to  an  attack  upon  his 
favourite  theory  of  the  pathology  of  that  disease.  Dr.  Chapman  had,  we  believe, 
previously  prepared  another  thesis  on  the  sympathetic  connections  of  the  sto- 
mach with  the  rest  of  the  body,  which  he  afterwards  read  before  the  Philadel- 
phia Medical  Society.  This  contained  the  substance  of  the  peculiar  views  on 
fever  and  other  diseases,  as  well  as  the  modus  operandi  of  medicines,  which  he 
has  since  taught.  While  a  student.  Chapman  found  time  to  become  a  frequent 
contributor  to  the  Port  Folio,  a  magazine  of  some  celebrity  in  its  day.  His 
contributions,  under  the  signature  of  Falkland,  had  considerable  popularity. 

In  1801,  he  went  abroad,  and  spent  four  years  chiefly  at  Edinburgh  and  Lon- 
don. He  remained  a  year  in  London,  the  private  pupil  of  Abernethy,  and 
thence  passed  to  Edinburgh.  Edinburgh  was  then  celebrated  equally  for  her 
school  of  medicine  and  her  literary  and  scientific  society.  Students  of  medicine 
resorted  thither,  as  nov«r  to  Paris,  from  all  parts  of  the  world.  Nearly  all  our 
American  physicians  of  the  olden  time,  Morgan,  Shippen,  Knhn,  Rush,  Wis- 
tar,  and  many  others  received  their  education  at  Edinburgh.  It  may  be  sup- 
posed that  Dr.  Chapman  made  the  most  of  his  opportunities  in  the  distinguished 
circles  of  the  modern  Athens.  He  was  enabled  to  see  not  a  little  of  the  eminent 
persons  of  those  days,  and  enjoyed  considerable  intimacy  with  Dugald  Stewart, 
the  Earl  of  Buchan,  and  Brougham,*  then  a  fellow  student.  Before  his  depar- 
ture from  Edinburgh,  Lord  Buchan  gave  him  a  public  breakfast,  on  the  birth-day 
of  Washington,  at  which  a  number  of  distinguished  persons  were  present,  when 
he  took  the  occasion  to  entrust  him  with  an  interesting  relic,  valuable  from  a 
double  historical  association.  Lord  Buchan  had  presented  to  General  Wash- 
ington a  box  made  of  the  oak  that  sheltered  Sir  William  Wallace  after  the  bat- 
tle of  Falkirk,  with  a  request  "to  pass  it,  in  the  event  of  his  decease,  to  the 
man  in  his  country  who  should  appear  to  merit  it  best."  General  Washington, 
declining  so  invidious  a  designation,  returned  it  by  will  to  the  earl,  who  com- 
mitted it  to  Chapman,  to  be  delivered  to  Dr.  Rush,  with  a  view  to  its  being 
ultimately  placed  in  the  cabinet  of  the  college  at  Washington,  to  which  General 
Washington  had  bequeathed  a  large  sum. 

*  In  1809,  Dr.  Chapman  republished  here  Lord  (then  Mr.)  Brougham's  Speech 
before  the  House  of  Commons  on  the  British  Orders  in  Council,  with  a  biographiea! 
sketch  of  him,  in  which  he  predicted  his  future  eminence.  Lord  Brougham  was  then 
quite  a  young  man,  little  known  in  this  country. 

No.  VII.—JuLY,  1842,  21 


243  Jlmerican  Intelligence,  [July 

Dr.  Chapraan  returned  to  this  country  in  1804.  He  established  himself  in 
Philadelphia,  where  he  soon  afterwards  married.  His  attractive  manners  and 
reputation  for  talent  secured  his  almost  immediate  success  in  practice.  He 
became  the  favourite  physician  of  a  large  portion  of  the  higher  classes  of  Phila- 
delphia, and  has  continued,  for  more  than  thirty  years,  to  occupy  this  position. 
He  was  the  physician  and  confidential  friend  of  the  Count  de  ^urvilliers,  (Jo- 
seph Bonaparte,)  during  his  long  residence  in  Philadelphia  and  its  vicinity. 
From  the  count  he  gathered  a  large  fund  of  interesting  anecdote  of  the  illustri- 
ous brother  of  the  ex-king,  and  the  men  and  scenes  of  his  eventful  times,  from 
which  the  doctor  occasionally  draws.  In  his  day,  Dr.  Chapman  has  seen  much 
of  the  prominent  statesmen  of  the  United  States,  and,  though  never  entering 
into  politics,  he  is  familiar  with  the  personal  history  and  character  of  most  of 
our  public  men.  He  was  summoned  to  the  death-bed  of  General  Harrison, 
though  too  late  to  assist  in  the  treatment. 

As  a  practitioner.  Dr.  Chapman  is  distinguished  as  much  for  the  charm  of  his 
manner  in  the  sick  chamber,  as  for  skill  and  success  in  prescribing.  His  lively 
conversation  and  ever-ready  joke  are  often  more  effective  than  anodyne  or  cor- 
dial. Indeed,  in  cases  of  trifling  importance,  the  doctor  sometimes  prescribes 
little  else.  In  pleasant  chit-chat,  both  patient  and  physician  forget  the  object 
of  the  visit,  and  the  doctor  will  depart  and  "leave  no  sign"  for  pill  or  bolus. 
But,  when  roused  by  symptoms  of  actual  severity.  Dr.  Chapman  is  almost  une- 
qualled in  resources,  as  he  is  devoted  in  attentions.  Hence,  as  a  consulting 
physician,  his  great  powers  are  particularly  conspicuous.  Rapid  and  clear  in 
diagnosis,  inexhaustible  in  therapeutics,  self-relying,  never  discouraged,  never 
*'  giving  up  the  ship,"  he  is  the  physician  of  physicians  for  an  emergency. 

Dr.  Chapman  is  best  known  abroad  as  a  writer  and  a  lecturer.  Not  long  after 
his  return  home,  he  published  a  work  entitled  "  Select  Speeches,  Forensic  and  Par- 
liamentary ^"^  with  critical  and  illustrative  remarks,  in  five  8vo.  volumes,  which 
attracted  much  attention.  He  has  since,  however,  confined  his  pen  to  scientific 
topics.  The  year  of  his  return,  1804,  he  gave  a  private  course  upon  obstetrics, 
which  proved  so  popular,  that,  in  1806,  at  the  age  of  twenty-six,  he  was  elected 
adjunct  to  the  chair  of  Midwifery  in  the  University,  and  soon  afterwards  to  that 
of  the  Materia  Medica.  His  colleagues  of  that  day,  Shippen,  Rush,  Wistar, 
Physick,  James,  are  gone,  and  he  remains  the  senior  professor  in  the  Univer- 
sity, and,  doubtless,  the  oldest  lecturer  on  medicine  in  America.  The  course  of 
lectures  on  Materia  Medica  is  beyond  the  memory  of  the  writer  of  this  sketch. 
The  views  and  arrangement  adopted  by  the  lecturer  may,  however,  be  inferred 
from  his  "  Therapeutics,''''  to  which  allusion  will  be  made.  At  the  death  of 
Rush,  in  1812,  Chapman  was  transferred  to  the  chair  of  Theory  and  Practice, 
which  he  has  ever  since  filled. 

The  lectures  of  Professor  Chapman,  annually  delivered  to  large  classes,  dur- 
ing a  period  of  thirty  years,  are  of  course  familiar  to  no  small  portion  of  the  pro- 
fession of  the  United  States.  We  but  reflect  general  opinion,  in  pronouncing 
them  erudite,  elaborate,  and  highly  finished  compositions,  enriched  with  the 
stores  of  the  most  varied  reading  and  of  ample  personal  experience.  The  pro- 
fessor has,  we  believe,  continued  to  retain,  as  the  basis  of  his  course,  the  ori- 
ginal draft  at  first  prepared,  although  many  lectures  have  been  rewritten,  and 
the  whole  often  remodelled.  Keeping  pace  with  the  progress  of  medical  sci- 
ence. Professor  Chapman  is  yet  slow  to  adopt,  certainly  to  give  currency  to 
what  are  termed  the  novelties  of  the  day.  On  a  few  subjects,  his  opinions  dif- 
fer from  those  generally  received.  His  views  of  fever  are  of  the  ultra-solidist 
school,  and  of  course  at  variance  with  the  prevailing  doctrines.  It  is  foreign  to 
our  purpose,  however,  to  canvass  these  points  critically.  Dr.  Chapman's  deli- 
very of  his  lectures  is  animated  and  emphatic.  His  voice  is  clear,  not  of  great 
volume,  but  so  highly  pitched  as  to  seem  loud.  A  slight  nasal  intonation  gives 
it  a  peculiarity,  not  unpleasatit  when  the  ear  has  become  familiarized  to  it. 

In  addition  to  his  courses  at  the  University,  Dr.  Chapman  for  a  long  period 
gave  clinical  lectures  in  the  hospital  of  the  Philadelphia  Almshouse.  He  has, 
moreover,  for  upwards  of  twenty  years,  delivered  a  summer  course  of  lectures  in 


1842.]  American  Intelligence.  243 

the  Medical  Institute.  This  institution  was  founded  by  Dr.  Chapman,  although, 
as  we  learn,  he  has  never  participated  in  the  fees,  or  exercised  any  control  over 
the  appointments  to  the  chairs.  In  days  of  yore,  the  doctor  was  a  leading  de- 
bater at  the  Philadelphia  Medical  Society,  when  the  floor  of  that  society  was  a 
field,  in  which  the  ablest  members  of  the  profession  met  in  earnest  and  often 
vehement  discussion.  Dr.  Chapman  has  several  times  filled  the  honourable 
post  of  President  of  the  Society.  He  is  now  the  Senior  Vice-President  of  the 
American  Philosophical  Society,  and  has,  we  believe,  been  chosen  correspond- 
ing member  of  most  of  the  learned  societies  of  Europe. 

Dr.  Chapman's  principal  work  is  his  "  Therapeutics^''^  published  in  1817.  It 
has  gone  through  seven  editions,  one  surreptitious;  but  the  doctor  has  since 
refused  to  have  it  reprinted,  until  he  finds  time  to  bestow  on  it  a  thorough  re- 
vision. The  "  Therapeutics'''  has  enjoyed  a  long  popularity.  It  is  written  in  a 
very  attractive  style,  and,  as  is  well  known,  is  thoroughly  impregnated  with 
most  of  the  peculiar  and  original  views  of  the  author.  It  is,  perhaps,  hardly 
necessary  to  observe,  that  some  of  these  are  not  in  accordance  with  the  opinions 
of  a  large  portion  of  his  professional  brethren — as,  for  instance,  the  theory  of  the 
modus  operandi  of  medicines. 

In  1820,  Dr.  Chapman  commenced  the  publication  of  the  "Philadelphia 
Journal  of  the  Medical  and  Physical  Sciences,"  which  he  continued  to  edit  for 
many  years.  The  Journal  was  undertaken  with  liberal  views — the  doctor  never 
receiving  a  salary  for  his  services.  He  has  since  been  an  occasional  contribu- 
tor to  different  periodicals.  A  large  number  of  his  lectures  have  been  published 
in  the  previous  volumes  of  this  journal — elegantly  written  and  standard  mono- 
graphs on  a  variety  of  subjects. 

We  feel  that  this  sketch  does  very  imperfect  justice  to  one  of  the  brightest 
ornaments  of  the  profession.  It  has,  however,  the  merit  of  being  executed  in  a 
spirit  of  entire  candour. 

Observations  on  some  of  the  signs  of  live  and  still  birth,  in  their  applications 
to  Medical  Jurisprudence.  By  John  B.  Beck,  M.  D.,  Professor  of  Materia 
Medica  and  Medical  Jurisprudence  in  the  College  of  Physicians  and  Surgeons 
of  the  University  of  the  State  of  New  York. 

"In  all  cases  of  alleged  child  murder,  one  of  the  great  questions  to  be  estab- 
lished, is  the  fact  of  the  child's  having  respired  or  not.  As  the  signs  by  which 
this  is  to  be  determined  are  still  the  subject  of  much  difference  of  opinion  among 
medical  jurists,  it  becomes  important  to  enlarge  our  existing  stock  of  knowledge, 
by  the  accumulation  of  new  and  repeated  observations.  With  this  view,  I  have 
embraced  every  opportunity  that  has  been  thrown  in  my  way  of  examining  the 
dead  new-born  subject.  The  following  observations  are  founded  upon  the  ex- 
amination often  such  subjects,  which  I  have  been  enabled  to  make  through  the 
kindness  of  some  of  my  professional  friends.  To  Dr.  Wilson,  formerly  phy- 
sician of  the  Bellevue  Hospital,  from  which  institution  many  of  the  subjects 
were  furnished,  I  am  particularly  indebted.  As  the  circumstances  connected 
with  the  birth  of  each  are  known,  no  doubt  or  uncertainty  can  attach  to  the  ac- 
curacy of  the  conclusions  drawn  from  them. 

Among  the  tests  principally  relied  on  to  determine  this  question,  the  most 
important  are  the  following.  1.  The  static  test.  2.  The  hydrostatic  test.  3. 
The  state  of  the  ductus  arteriosus. 

1.  The  static  test.  This  test  is  founded  on  the  fact,  that  the  act  of  respiration 
causes  an  increase  in  the  weight  of  the  lungs.  There  are  two  forms  in  which 
this  test  has  been  applied.  The  first  is  by  comparing  the  weight  of  the  lungs 
with  that  of  the  body.  This  is  commonly  called  Ploucquet's  test.  The  second 
is  that  of  taking  the  absolute  weight  of  the  lungs. 

a.  Ploucquefs  test.  This  is  so  called  from  its  having  been  originally  sug- 
gested by  Ploucquet.  It  is  founded  on  the  fact,  that  as  soon  as  respiration 
takes  place  in  the  new-born  infant,  an  additional  quantity  of  blood  penetrates 
the  lungs,  in  consequence  of  which,  these  organs  become  heavier  than  anterior 
to  respiration.     As  the  weight  of  the  body  of  the  child  cannot  undergo  any 


244  American  Intelligence.  [July 

change,  he  sug^gested  accordingly,  that  a  comparison  of  the  weight  of  the  body 
of  the  child  with  the  weight  of  its  lungs,  would  furnish  a  test  by  which  to  de- 
termine whether  it  had  respired  or  not.  From  the  few  observations  which  he 
made,  he  came  to  the  conclusion  that  where  respiration  had  not  taken  place,  the 
proportion  between  the  weight  of  the  lungs  and  that  of  the  body,  was  as  1  to  70; 
while  on  the  other  hand,  where  respiration  had  taken  place,  it  was  as  1  to  35; 
or  in  other  words,  that  the  weight  of  the  lungs  was  doubled  in  consequence  of 
respiration.  A  test  so  beautiful  as  this,  and  founded  apparently  upon  principles 
so  truly  physiological,  it  was  hoped,  would  aid,  very  materially,  to  solve  this 
important  question.  Numerous  experiments  and  observations  were  accordingly 
made  to  test  its  accuracy  in  actual  practice;  and  the  result  has  been,  that  while 
some  appreciate  it  very  highly,  by  others  it  is  viewed  as  altogether  uncertain. 
In  the  ten  cases  which  I  have  examined,  the  proportions  are  the  following: 

Children  that  had  respired.  Children  that  had  not  respired. 

1. 1  :  43                                   1. 1  :  58 

2. 1  :  35                                   2. 1  :  36 

3. 1  :  44                                   3. 1  :  49 

4. 1  :  32 

Average,     1:40                                  5. 1:50 

6. 1  :  52 

7. 1  :  54 


Average,  1  :  47 
Now  the  conclusions  to  be  drawn  from  these  observations,  are  manifestly  ad- 
verse to  the  accuracy  of  this  test.  Taking  the  individual  cases,  there  is  not  a 
single  one  of  those  which  had  not  respired,  which  reach  the  proportions  laid 
down  by  Ploucquet,  while  in  the  same  list,  cases  2  and  4  are  very  nearly  the 
proportions  laid  down  for  children  that  have  respired.  If  we  take  the  general 
averages,  too,  of  the  cases,  we  find  that  they  do  not  correspond  with  the  pro- 
portions suggested  by  Ploucquet. 

Since  the  time  of  Ploucquet,  a  great  number  of  observations  have  been  made 
by  other  persons,  and  as  the  result,  they  have  all  fixed  upon  different  proportions. 
The  following  are  some  of  them. 

Before  respiration.  After  respiration. 

Schmitt, 1  :  52  1  :  35 

Chaussier,     -    1  :  49  1  :  39 

Devergie,    -  -    1  :  60  1  :  45 

These,  as  being  deduced  from  a  large  number  of  cases,  come  nearer  the  true 
proportions  than  those  of  Ploucquet,  and  correspond  more  nearly  with  my  own 
observations.  Still,  however,  it  is  to  be  recollected  that  they  are  mere  average 
numbers,  and  therefore  do  not  meet  the  circumstances  of  individual  cases,  which 
of  course  they  ought  to  do,  for  the  purpose  of  rendering  them  practically  avail- 
able. It  may  be  asked,  then,  is  this  test  to  be  rejected  altogether!  As  an  infal- 
lible one,  it  certainly  should  be.  Notwithstanding  this,  it  is  still,  I  think,  valu- 
able as  furnishing  corroborative  proof,  and  should,  therefore,  never  be  neglected. 
It  should  always  be  taken  in  connection  with  the  other  signs;  and  when  this  is 
done,  it  may  aid  very  materially  in  coming  to  a  correct  conclusion. 

h.  Absolute  weight  of  the  lungs.  By  some  it  has  been  supposed,  that  the  ac- 
tual weight  of  the  lungs  would  furnish  another  criterion  of  the  fact  of  respiration 
having  taken  place  or  not.  Accordingly,  an  average  weight  of  1000  grains  has 
been  proposed  for  the  lungs  of  a  child  which  has  respired,  and  600  grains  for 
those  of  a  child  which  has  not  respired.  A  moment's  reflection,  however,  must 
convince  us  that  this  is  still  more  uncertain  than  the  test  of  Ploucquet.  Chil- 
dren born  at  the  full  time,  we  know,  differ  greatly  in  their  weight,  and  of  course 
there  must  be  a  corresponding  difference  in  the  weight  of  the  lungs.  I  have 
known  a  child  born  at  the  full  time,  healthy  and  perfect  in  every  respect,  and 
yet  weigh  only  four  pounds;  while  children  weighing  eight,  nine  and  ten  pounds 


1842.]  American  Intelligence.  245 

are  by  no  means  uncommon.  The  lungs,  therefore,  of  a  child  which  had  not 
respired,  of  nine  pounds,  would  probably  weigh  more  than  those  of  a  child  of 
four  pounds,  which  had  respired;  and  such  has  been  found  to  be  the  case  by 
actual  observation.  In  the  cases  which  I  have  examined,  the  following  were 
the  weights. 

Before  respiration.  After  respiration. 

1. 540  grains.  1. 396  grains. 

2. 720  2. 800 

3. 900  3. 814 

4.  --....  -  890  

5. 900  Average,       670 

6. 690 

7. 689 

Average,  761 

An  analysis  of  these  weights  will  show  at  once  how  fallacious  this  test  must 
be.  We  have  here,  in  three  cases,  before  respiration  took  place,  the  lungs 
weighing  more  than  in  those  which  had  respired;  while  the  general  average 
weight  is  greater  in  those  which  had  not  respired — ^just  the  reverse  of  what  it 
ought  to  be  according  to  this  test. 

2.  The  hydrostatic  test.  This  testis  founded  upon  the  difference  in  the  spe- 
cific gravity  of  the  lungs  before  and  after  respiration.  In  other  words,  lungs 
which  have  respired  will  float  in  water,  while  those  which  have  not  respired 
will  sink.  Every  observation  which  I  have  been  enabled  to  make,  has  con- 
firmed me  in  the  general  accuracy  of  this  test.  It  is  liable,  however,  to  certain 
fallacies  or  objections  which  require  to  be  understood,  to  enable  us  to  make  a 
correct  practical  application  of  the  test.  On  the  one  hand,  lungs  which  have  not 
respired  may  float  from  putrefaction — from  artificial  inflation — from  emphysema; 
while,  on  the  other  hand,  lungs  which  have  respired  may  sink  from  disease,  or 
from  the  respiration  being  feeble  or  imperfect.  Of  these  I  shall  only  notice  two, 
as  they  are  the  only  ones,  of  which  illustrations  have  occurred  in  the  cases 
which  I  have  examined.  They  are,  however,  the  most  important  of  all  the  ob- 
jections. 

a.  Putrefaction.  That  the  lungs  of  a  child  which  has  not  respired  may  float 
in  consequence  of  putrefaction,  although  at  one  time  questioned,  is  beyond  doubt. 
The  case  which  I  shall  presently  relate,  independent  of  numerous  others,  estab- 
lishes this  fact.  The  modes  of  distinguishing  it  from  the  floating  of  respira- 
tion are  simple  and  obvious,  a.  By  the  air  bubbles  being  visible  under  the 
external  covering  of  the  lungs.  In  vital  respiration  this  is  not  the  case.  b.  By 
the  ease  with  which  the  air  can  be  pressed  out  of  the  lungs.  By  simply 
squeezing  them  in  the  hand,  they  can  readily  be  made  to  sink  in  water.  In 
vital  respiration  this  cannot  be  done.  c.  By  the  sinking  of  the  internal  portion 
of  the  lungs.  The  air,  in  putrefaction,  forms  on  the  surface  of  the  lungs;  and 
hence  the  internal  part,  if  cut  out  and  put  into  water,  will  not  float.  In  vital 
respiration,  the  internal  part  will  float  more  readily  than  the  external  part  of  the 
lungs. 

Case.  Aug.  25,  1838.  A  still  born  child  was  presented  for  examination  by 
Dr.  Wilson  of  Bellevue  Hospital.  The  child  had  been  born  two  days  before. 
The  weather  being  intensely  hot,  decomposition  had  commenced.  The  body 
was  of  a  greenish  colour;  the  abdomen  greatly  distended;  the  skin  peeling  off 
in  several  parts  of  the  body.  The  cord  about  two  inches  long,  smooth,  soft, 
moist  and  flexible;  weight,  31680  grains;  length,  22  inches;  the  umbilicus 
twelve  inches  from  the  top  of  the  head — the  centre  of  the  body,  accordingly,  a 
little  above  the  umbilicus.  On  opening  the  chest,  the  surface  of  the  lungs  was 
found  covered  with  air  bubbles,  varying  from  the  size  of  a  large  pea  to  a  pin's 
head.  On  the  posterior  part  of  these  organs  there  were  no  air  bubbles.  The 
colour  of  the  lungs  was  dark  red,  with  here  and  there  spots  of  a  lighter  hue.  The 
lungs  taken  out  of  the  chest,  with  the  heart  and  thymus  gland  attached,  floated 

21* 


246  American  Intelligence,  [J"ly 

in  water;  separated  from  the  heart  and  thymus  gland,  they  also  floated,  as  did 
also  the  latter  organs.  The  weight  of  the  lungs  was  540  grains;  making  the 
relative  weight  to  that  of  the  body  as  1:58.  A  portion  of  the  internal  part  of 
the  right  lung  being  cut  out,  sank  in  water.  Both  lungs  were  now  subjected  to 
moderate  pressure,  and  after  this  they  sank  in  water.  Each  lung  was  now  cut 
into  ten  pieces,  and  on  being  put  into  water,  some  sank,  while  others  floated. 
On  being  moderately  compressed  between  the  fingers,  each  separate  section 
sank  rapidly  to  the  bottom  of  the  vessel.  The  ductus  arteriosus  was  cylindrical 
in  shape,  and  about  the  size  of  the  pulmonary  artery;  the  foramen  ovale  open; 
the  umbilical  vessels  and  ductus  venosus  pervious;  and  meconium  in  the  large 
intestines. 

This  case  illustrates,  very  strikingly,  the  fact  that  the  lungs  of  a  still  bom 
child  may  float  from  putrefaction,  and  at  the  same  time  confirms  the  accuracy  of 
the  tests,  by  which  it  may  be  distinguished  from  the  floating  which  is  the  result 
of  vital  respiration. 

h.  Jirtificial  inflation.  That  the  lungs  of  a  child  which  has  not  respired  may 
be  artificially  inflated,  so  as  to  cause  them  to  float,  though  doubted  by  some,  is 
well  established;  and  when  this  is  the  case,  it  presents  one  of  the  most  puzzling 
problems — to  distinguish  it  from  vital  respiration.  The  only  test  upon  which 
any  reliance  can  be  placed,  is  the  application  of  suitable  pressure  to  the  lungs. 
If  the  floating  be  the  result  of  vital  respiration,  no  degree  of  pressure  can  expel 
the  air  from  the  lungs  sufficiently  to  cause  them  to  sink;  while,  on  the  other 
hand,  in  cases  of  artificial  inflation,  this  can  be  done. 

Case.  Dec.  G,  1839.  Examined  a  child  which  had  been  still  born,  but  which 
the  accoucheur  had  attempted  to  resuscitate  by  blowing  into  its  mouth,  but 
without  success.  Length,  twenty  inches;  the  centre  of  the  body  at  the  um- 
bilicus; head  full  of  hair;  nails  full  grown,  and  the  body  perfectly  sound; 
weight,  47040  grains.  No  inflammatory  circle  around  the  navel;  thorax  flat. 
On  opening  the  chest,  the  lungs  were  found  in  the  upper  and  lateral  portions  of 
the  chest,  leaving  the  pericardium  and  diaphragm  uncovered.  On  taking  out 
the  lungs,  the  right  lung  was  of  a  dark  red  colour,  with  the  exception  of  the 
lower  pari  of  the  upper  lobe,  and  the  upper  part  of  the  lower  lobe,  which  were 
of  a  bright  red.  The  middle  lobe  had  alternate  patches  of  bright  red  and  dark 
red.  The  left  lung  was  dark  red,  with  the  exception  of  the  extremity  of  the 
lower  lobe  and  the  posterior  part  of  the  upper  lobe,  which  were  bright  red. 
Distinct  crepitus  in  both  lungs  in  the  parts  corresponding  to  the  bright  patches. 
The  weight  of  the  lungs  was  900  grains,  making  the  relative  weight  to  that  of 
the  body  as  1:52.  Both  lungs  floated  in  water.  The  separate  lobes  of  each 
lung  also  floated.  The  right  lung  was  then  cut  into  twelve  pieces,  all  of  which 
floated;  but  all  the  pieces  sank  after  being  subjected  to  pressure.  The  left  lung 
was  cut  into  ten  pieces,  and  all  but  one  floated.  On  pressure  being  made,  they 
all  sank.  The  pressure  was  made  by  placing  them  in  a  piece  of  strong  linen, 
and  then  twisting  and  wringing  them;  after  this  they  were  placed  under  a  large 
flat  stone. 

The  ductus  arteriosus  was  as  large  as  the  trunk  of  the  pulmonary  artery; 
cylindrical  in  shape,  and  much  larger  than  the  branches  of  the  pulmonary 
artery.  The  foramen  ovale,  ductus  venosus,  umbilical  arteries  and  veins  all 
open. 

This  case  is  exceedingly  interesting,  as  illustrating  the  effects  of  artificial  in- 
flation, and  as  showing  how  nearly  they  resemble  those  of  vital  respiration. 
The  floating  of  the  lungs  was  almost  perfect,  and  the  weight  of  the  lungs  (900 
grains)  was  nearly  that  of  the  usual  average  standard  of  children  that  have  re- 
spired. On  the  other  hand,  the  sinking  of  the  lungs,  after  due  pressure,  the 
relative  weight  of  the  lungs  and  the  body,  1:53,  and  the  state  of  the  ductus  ar- 
teriosus, were  in  favour  of  artificial  inflation. 

3.  State  of  the  ductus  arteriosus.  This  is  also  called  the  Vienna  test, 
from  its  being  originally  suggested  by  Prof.  Bernt,  of  Vienna.  It  is  founded  on 
certain  changes,  which  take  place  in  the  ductus  arteriosus,  immediately  after  res- 
piration.    In  the  mature  foetus  before  respiration,  this  duct  is  about  half  an  inch 


I 


1842.]  American  Intelligence.  247 

long,  cylindrical  in  shape,  with  a  diameter  about  equal  to  that  of  the  pulmonary 
artery,  and  more  than  double  the  size  of  the  branches  of  that  artery,  each  of 
which  is  equal  to  that  of  a  crow  quill.  If  the  child  have  respired  a  few  mo- 
ments, the  duct  becomes  conical  in  shape,  with  its  contracted  part  towards  the 
aorta.  If  the  child  have  respired  for  some  hours  or  a  day,  it  becomes  cylindri- 
cal again  in  shape,  but  lessened  in  length  and  diameter.  It  is  much  less  now 
than  the  pulmonary  artery,  and  not  larger  than  the  branches  of  that  artery.  If 
the  child  have  respired  for  several  days  or  a  week,  the  duct  will  be  found  still 
more  contracted;  its  diameter  will  be  not  larger  than  a  crow  quill,  while  the 
branches  of  the  pulmonary  artery  are  much  enlarged  to  the  size  of  a  goose  quill. 

The  result  of  my  observations  goes  strongly  to  support  the  accuracy  of  these 
observations.  In  six  still  born  children,  I  found  the  ductus  arteriosus  cylindri- 
cal in  shape,  and  about  the  size  of  the  main  trunk  of  the  pulmonary  artery,  and 
considerably  larger  than  the  branches  of  the  pulmonary  artery — in  some  cases, 
double  the  size.  In  a  seventh  still  born  child,  I  found  it  nearly  of  the  size  of 
the  pulmonary  artery,  but  not  much  larger  than  its  branches.  In  a  child 
which  had  lived  four  days,  the  ductus  arteriosus  was  cylindrical,  three  lines 
in  length,  and  about  the  size  of  a  crow  quill,  and  not  more  than  half  the  size 
of  the  pulmonary  artery.  In  a  child  which  had  lived  three  days,  the  ductus 
arteriosus  was  two  and  a  half  lines  long  and  cylindrical;  about  one  third  the 
size  of  the  pulmonary  artery,  and  somewhat  smaller  than  the  branches  of  that 
artery.  In  a  child  which  lived  forty-six  hours,  the  ductus  arteriosus  was  one 
fourth  of  an  inch  long,  cylindrical  in  shape,  less  than  half  the  size  of  the  pul- 
monary artery  and  about  equal  to  the  branches  of  that  artery. 

Although  the  foregoing  observations,  generally  speaking,  confirm  the  accuracy 
of  this  test,  it  is  to  be  recollected  that  it  is  not  to  be  relied  upon  in  all  cases. 
This  has  been  shown  particularly  by  Orfila. 

I  have  thus,  as  briefly  as  possible,  recorded  the  results  of  the  foregoiug  ob- 
servations, without  indulging  in  the  many  comments  which  naturally  suggest 
themselves.  I  have,  however,  in  another  place,*  so  fully  discussed  all  the 
points  connected  with  this  subject  as  to  render  them  at  present  unnecessary. — 
Trans.  Med.  Soc.  Stsite  of  New  York,  1842. 

Inversion  of  the  Uterus. — D.  Humphreys  Storer,  M.  D.,  reported  to  the  Bos- 
ton Society  for  Medical  Improvement,  April  11,  1842,  the  following  case  of 
inversion  of  the  uterus. 

He  was  called  to  a  woman  in  labour.  In  ten  or  fifteen  minutes  there  came 
two  smart  pains,  and  the  child  was  born.  In  five  minutes  the  placenta  was 
thrown  off.  The  cord  was  not  touched,  except  to  divide  it  and  remove  the 
child.  On  putting  his  hand  under  the  clothes,  to  take  away,  as  he  supposed, 
the  placenta,  he  found  that  he  had  hold  of  the  uterus  with  the  placenta  attached. 
He  removed  the  placenta,  put  his  fingers  to  the  fundus  of  the  uterus,  and  passed 
it  up  without  the  slightest  difficulty.  There  was  some  flowing  from  the  uterus 
where  the  placenta  was  detached,  but  not  great,  and  none  after  it  had  passed 
up.  The  woman  was  very  much  prostrated,  and  for  an  hour  appeared  as  if  she 
was  dying.  She  however  revived,  and  the  next  morning  was  comfortable. 
This  case  proves  that  inversion  may  take  place,  without  the  interference  of  the 
practitioner.  For  no  traction  whatever  was  made  upon  the  cord,  which  was  of 
the  usual  length,  and  not  encircling  the  child. 

Drs.  Dewees,  Burns  and  Gouch,in  cases  of  inversion,  advise,  when  it  can  be 
accomplished,  the  return  of  the  uterus  before  the  removal  of  the  placenta,  on 
account  of  the  dangerous  hemorrhage  which  is  otherwise  liable  to  ensue.  Dr. 
Bard  recommends  the  previous  removal  of  the  placenta. 

Dr.  Storer  followed  in  this  case  the  practice  of  Dr.  Bard,  and  the  ease  with 
which  the  uterus  was  returned,  and  the  happy  convalescence  thus  far,  she  being 
as  well  to-day  (the  sixteenth  day  after  delivery,)  as  she  had  been  at  the  same 

*  Elements  of  Medical  Jurisprudence,  by  T.  Romeyn  Beck,  M.  D.,  and  John  B. 
Beck,  M.  D. 


248  American  Intelligence,  [July 

period  during  any  former  pregnancy,  proves  the  course  to  have  been  a  judicious 
one.  The  placenta  was  very  large,  and  he  believed  that  had  he  made  any 
attempt  to  return  it,  he  would  have  met  with  difficulty,  from  its  mere  bulk.  In 
a  case  of  inverted  uterus,  related  by  Dr.  Meigs,  of  Philadelphia,  in  his  Practice 
of  Midwifery,  he  was  unable  to  return  it  with  the  placenta,  and  at  the  sugges- 
tion of  Dr.  James,  the  after-birth  was  removed  from  its  attachments.  After- 
wards, with  considerable  difficulty,  a  reduction  of  the  organ  was  effected. 

The  little  blood  which  was  lost  after  the  placenta  was  removed,  in  the  case 
reported  by  Dr.  Storer,  showed,  he  thought,  that  the  great  dread  of  uterine 
hemorrhage,  which  is  felt  by  physicians  from  the  removal  of  the  placenta,  even 
should  no  uterine  contraction  immediately  occur,  is  not  well  founded.  •  As  soon 
as  the  placenta  was  detached,  the  hemorrhage  ceased,  and  although  the  uterus 
was  so  completely  relaxed  as  to  allow  the  hand  to  pass  with  perfect  freedom, 
without  the  slightest  muscular  contraction  being  perceived,  there  was  no 
bleeding. — New  England  Quarterly  Journ.  of  Med.  ^  Surg.,  July?  1842. 

Operation  for  Artificial  Pupil  and  subsequent  section  of  the  Rectus  superior.  By 
J.  Kearny  Rodgers,  M.  D.,  Surgeon  to  the  N.  Y.  fiospital. — Francis  Ander- 
son, aged  about  twenty-five  years,  while  engaged  on  the  Albany  and  Boston 
Railroad,  in  December,  1838,  was  severely  injured  by  the  explosion  of  powder. 
The  left  forearm  was  amputated;  the  right  eye  sunk,  and  vision  nearly  destroyed 
in  the  left. 

September  22d,  1841.  He  was  admitted,  under  my  care,  into  the  New  York 
Eye  Infirmary,  with  the  hope  of  regaining  the  sight  of  the  left  eye.  There  was 
a  dense  opacity  of  the  lower  part  of  the  cornea,  occupying  two-thirds  of  its 
whole  area,  leaving  a  crescentic  upper  portion  transparent;  the  greatest  width  of 
which,  was  about  one-fourth  the  diameter  of  the  cornea.  The  iris  adhered  to 
this  opaque  part,  that  had  evidently  been  the  seat  of  a  perforating  ulcer,  or 
slough;  and  the  pupil  was  drawn  downward.  On  examining  the  eye  from 
above,  the  edge  of  the  pupil  could  be  seen;  and  I  determined  to  give  him  the 
opportunity  of  any  benefit  to  be  derived  from  Gibson's  operation  for  artificial 
pupil.  This  was  performed  on  the  26th  of  September,  in  the  manner  recom- 
mended by  Guthrie;  making  an  incision  through  the  cornea,  with  a  cataract 
knife,  and  withdrawing  it  "with  a  rip."  The  iris  protruding  this  wound  was 
lemoved  by  a  pair  of  curved  scissors,  and  the  operation  completed  in  half  a 
minute. 

No  inflammation  followed  the  operation,  and  vision  was  greatly  improved,  so 
as  to  enable  him  to  see  large  letters.  The  upper  lid,  however,  usually  covered 
the  pupil,  and  on  the  16th  of  October,  for  the  purpose  of  raising  it,  so  that  its 
edge  should  not  interfere  with  the  pupil,  I  removed  a  portion  of  its  integuments, 
(after  the  ordinary  operation  for  entropion,)  with  benefit.  Still  the  levator  pal- 
pebrae  superioris  could  not  raise  the  lid  sufficiently  at  all  times,  and  the  assist- 
ance of  the  hand  was  occasionally  required.  He  returned  home,  however,  grati- 
fied with  the  amendment  derived  from  the  operations. 

In  March  of  the  present  year,  he  again  called  on  me;  and  finding  that  the 
upper  lid  interfered  with  vision,  I  resolved  on  an  operation,  which  I  believe  has 
once  been  performed,  in  similar  circumstances,  of  dividing  the  rectus  superior 
oculi,  and  thus  allow  the  rectus  inferior  to  draw  down  the  pupil  beyond  the 
margin  of  the  upper  lid.  This  was  done  on  the  8th,  in  the  way  I  ordinarily 
operate  for  strabismus.  The  upper  and  under  lids  being  held  by  a  practised 
assistant,  I  raise  the  conjunctiva  with  blood-vessel  forceps,  and  cut  through  it 
with  straight  scissors.  The  tendon  being  laid  bare,  I  pass  a  curved  probe  under 
it,  and  divide  with  a  pair  of  bent  scissors. 

Very  little  inflammation  ensued,  and  the  eye  was  drawn  down  so  as  to  im- 
prove his  vision,  but  not  as  much  as  I  expected,  and  certainly  not  corresponding 
to  the  change  that  usually  takes  place  after  the  operation  of  dividing  the  rectus 
internus  in  strabismus.  He  now  left  me,  satisfied  with  the  amended  sight,  and 
the  result  of  the  operation. — New  York  Med.  Gaz.,  April  20,  1842. 


1842.]  American  Intelligence.  249 

Rupture  of  the  Uterus  from  external  injury. — The  following  shocking'  ex- 
ample of  meddlesome  midwifery,  is  related  by  Dr.  F.  Hyde,  in  the  Boston  Medical 
and  Surgical  Journal  for  I9th  Jan.  last. 

"  On  Jan.  1,  1836,  Mrs.  Arnold,  of  Freetown,  Cortland  Co.,  N.  Y.,  set.  35 
years,  who  had  generally  enjoyed  good  health,  had  borne  several  children,  and 
was  at  the  full  period  of  utero-gestation,  having  occasion  to  step  out  of  the 
house,  while  walking  upon  the  ice,  fell,  striking,  with  the  entire  weight  of  her 
body,  the  anterior  of  the  abdomen,  and  producing  a  sensation  (to  use  her  own 
phrase),  as  if  she  were  split  open,  in  the  belief  of  which  she  was  persistent. 
Faintness  followed  at  intervals,  amounting  to  complete  syncope,  during  the  first 
twenty-four  hours  after  the  injury,  with  incessant  vomiting,  coldness  of  surface 
and  extremities,  countenance  sunken,  and  a  deathlike  aspect.  The  physician 
and  friends  in  attendance  supposed  the  case  must  be  fatal,  and  had  little  or  no 
confidence  in  any  means  which  they  could  adopt.  Under  these  circumstances, 
my  partner,  Dr.  Miles  Goodyear,  was  called,  at  the  end  of  twenty-four  hours 
after  the  injury  had  been  received.  He  learned  that  there  had  been  no  motion  of 
the  child  since  the  fall;  patient  complained  of  occasional  abdominal  pains;  os 
uteri  not  in  the  least  dilated;  external  appearance  of  abdomen  natural,  but  ex- 
tremely tender  to  the  touch.  Had  been  no  evacuation  from  the  bowels  since 
the  injury.  Enemata  were  now  administered,  but  not  sufficiently  retained  to 
produce  their  desired  effect.  Reaction  had  now  come  on  to  some  extent;  pulse 
110  and  small;  tongue  thinly  coated  and  dry;  mouth  of  uterus  still  rigid  and 
unyielding.  Ordered  10  grs.  of  protochloride  of  mercury  to  be  given,  and  re- 
peated at  the  end  of  four  hours,  and  followed  by  a  dose  of  sulph.  magnesia, 
which  in  the  course  of  five  or  six  hours  produced  free  intestinal  evacuations. 
Vomiting  not  so  frequent,  general  symptoms  nearly  the  same.  It  was  now 
some  ten  or  twelve  hours  since  the  arrival  of  my  partner,  who  advised  mild 
febrifuge  remedies  to  be  continued,  and  left  the  patient  in  charge  of  the  attending 
physician,  who  stated  that  he  should  recall  him  on  the  least  change  of  symp- 
toms. 

"  Accordingly,  in  about  thirty-six  hours  afterwards,  he  was  again  called,  when 
I  saw  the  patient  with  him  for  the  first  time.  We  found  her  with  countenance 
more  deathly,  pulse  120  and  more  feeble,  tongue  thickly  coated  and  dry  in  the 
centre,  less  vomiting,  tenderness  of  abdomen  not  so  much,  and  patient  did  not 
complain  of  pain  in  this  region,  more  than  of  other  parts.  Bowels  had  moved 
freely,  and  evacuations  not  peculiarly  offensive.  The  general  appearance  of  the 
patient  indicated  the  delivery  of  the  child,  if  it  were  ever  to  be  done.  But  upon 
examination,  we  found  no  relaxation  or  dilatation  of  the  os  uteri,  nor  was  the 
least  effort  on  the  part  of  the  uterus  to  be  discovered.  We  now  proceeded  with 
the  steps  of  a  forced  labour  and  delivery  of  the  child.  Accordingly,  the  dilata- 
tion was  commenced;  a  process  so  obstinately  resisted  by  the  unyielding  state  of 
the  parts,  as  to  require  from  four  to  Jive  hours  to  effect  a  delivery  of  the  child.  It 
may  not  be  improper  to  say  here,  that  to  produce  sufficient  dilatation  in  this  case,  for 
the  accomplishment  of  the  object  in  quedion,  was  no  very  inconsiderable  labour,  the 
hand  of  the  operator  requiring  frequent  intervals  of  rest,  to  enable  it  to  accomplish 
its  purpose.  The  child  was  large,  and  dead  as  was  supposed  previously,  but  no 
disorganization  had  yet  taken  place,  and  everything  had  thus  far  been  accom- 
plished independent  of  any  proper  or  natural  function  of  the  uterus.  Profuse 
hemorrhage  now  came  on;  the  uterus  not  exhibiting  the  least  contractile  effort. 
The  hand  was  immediately  returned,  detaching  the  placenta  with  facility 
until  it  arrived  at  the  upper  and  anterior  portion  of  the  organ,  when  it  met  a 
resistance,  which  seemed  to  be  a  perfectly  firm  adhesion  of  the  placenta  and 
uterus,  extending  over  a  surface  of  from  four  to  five  inches,  which  could  not  be 
broken  up  with  any  prudent  exertion.  Patient  was  now  much  exhausted, 
extremities  cold,  pulse  scarcely  perceptible  at  the  wrist,  hemorrhage  had  nearly 
ceased.  In  this  state  of  things  we  concluded  that  any  further  effort  to  detach 
the  placenta  would  not  only  be  unavailing,  but  inexpedient,  and  to  separate  the 
detached  mass  from  the  adherent  portion  would  be  attended  with  the  most  immi- 
nent danger.     Patient  was  now  placed  in  bed,  stimulants  freely  given,  with 


250  American  Intelligence,  [July 

frictions  upon  the  surface,  and  sinapisms  to  the  wrists  and  ankles.  We  left  the 
patient  in  care  of  the  attending  physician,  four  days  having  elapsed  since  the 
injury  was  inflicted. 

"  At  the  expiration  of  twenty-four  hours  we  saw  the  patient  again;  there  had 
been  very  little  hemorrhage,  no  movement  of  bowels,  external  appearances  nearly 
the  same  as  when  we  left.  Patient  expressed  herself  better  than  she  had  been 
before  during  her  illness,  but  still  the  features  were  more  cadaverous.  An 
enema  was  given,  which  procured  free  and  dark  fetid  discharges  from  the 
bowels.  She  now  began  to  complain  much  of  pain  in  the  region  of  the  stomach. 
Singultus,  and  vomiting  of  a  green,  viscid  fluid,  of  fetid  odor,  now  came  on; 
abdomen  more  distended,  pulse  much  more  rapid  and  feeble,  and  the  already 
prostrated  powers  of  the  system  unequivocally  told  that  they  would  soon  sink. 
In  a  few  hours  death  occurred,  it  being  the  sixth  day  from  the  time  of  the  ac- 
cident. 

^^  Autopsy  sixteen  hours  after  Death.  On  opening  abdomen  gangrenous  spots 
were  to  be  seen  on  the  inner  surface  of  parietes  for  four  or  five  inches  around  the 
umbilicus.  Some  portions  of  peritoneum  adherent  to  intestines,  while  other 
parts  were  softened  in  structure.  Much  fetid  gas  escaped  from  the  cavity.  The 
next  thing  met  with,  worthy  of  note,  was  a  full-sized  and  properly-formed  fcetus, 
with  its  extremities  and  body  in  the  same  relative  situation  in  which  nature  had 
placed  them  in  utero.  The  head  and  shoulders  were  lying  closely  upon  the  ab- 
dominal parietes,  to  which  a  portion  of  the  placenta  was  adherent,  to  the  right 
and  left  of  umbilicus,  extending  downwards,  and  laterally  from  three  to  four 
inches,  the  child  lying  anterior  to  all  the  abdominal  viscera.  Intestines  morti- 
fied at  various  points.  The  friends  objecting  to  a  removal  of  the  child,  the 
facilities  for  further  examination  were  not  as  ample  as  the  case  demanded.  The 
rupture  of  the  uterus  occupied  its  superior  and  anterior  portions,  through  which 
the  child  must  have  escaped,  with  its  own  placenta,  at  the  time  of  the  accident. 
Very  little  blood  was  found  in  the  cavities,  but  a  considerable  quantity  of  serous 
fluid.  It  will  be  recollected  that  there  was  no  external  hemorrhage  at  the  time 
the  injury  was  received,  and  that  there  had  been  repeated  evacuations  from  the 
bowels.  It  is  certain  that  some  contraction  must  have  followed  the  rupture, 
from  the  absence  of  hemorrhage  at  the  time;  and  that  some  inflammation  super- 
vened on  the  injury,  which  produced  the  adhesions  met  with  in  the  effort  to  re- 
move the  placenta  at  the  time  of  the  delivery  of  the  child." 

Ligature  of  the  External  Iliac  Artery. — In  our  No.  for  October  1841,  p.  524, 
we  noticed  a  case  of  inguinal  aneurism,  in  which  this  operation  had  been  suc- 
cessfully performed  by  Dr.  E.  Peace.  The  following  are  the  details  of  the  case, 
as  reported  by  the  operator,  in  our  cotemporary  the  Medical  Examiner. 

John  Erwin,  a  seaman,  aged  28  years,  of  robust  constitution  and  of  healthy 
parents,  was  admitted  into  the  Pennsylvania  Hospital  July  17th,  1841,  with  in- 
guinal aneurism  on  the  right  side.  Four  months  previous  to  this  period,  after  a 
fall  received  during  a  severe  and  long  contested  wrestling-match  he  had  severe 
pain  in  right  groin,  which  however  left  him  in  the  course  of  a  few  days.  He 
then  continued  well  for  two  months,  suffering  only  from  occasional  uneasiness 
at  the  knee,  at  the  end. of  which  time  there  was  a  return  of  the  pain  in  his  groin 
— he  then  observed  for  the  first  time  a  small  tumour  of  the  size  of  a  walnut, 
which  has  continued  to  increase  in  size  and  accompanied  with  such  an  increase 
of  pain  as  to  have  incapacitated  him  from  walking  during  the  last  three  days. 
The  patient  thinks  that  the  tumour  has  increased  one-half  in  size  during  the  last 
seven  days.  He  called  upon  an  apothecary  for  advice,  who  applied  forty  leeches 
and  recommended  hot  poultices. 

LFpon  examining  the  patient  on  the  afternoon  of  his  entrance  into  the  hospi- 
tal, we  found  a  pulsating  tumour  occupying  the  course  of  the  right  femoral 
artery,  extending  from  one  inch  above  Poupart's  ligament  to  three  and  a  half 
inches  below  it.     The  transverse  diameter  of  the  tumour  was  four  inches. 

Compressing  the  aorta  arrested  the  pulsation  of  the  aneurism,  but  without 
producing  any  diminution  of  its  volume. 


1842.]  American  Intelligence.  251 

The  skin  over  the  tumour  is  reddened,  pits,  and  the  pain  is  deep-seated  and 
very  severe.  The  inner  side  of  the  knee  is  also  the  seat  of  great  pain;  the  whole 
limb  is  swollen;  the  sensibility  is  natural  except  upon  the  anterior  surface  of 
the  thigh.  No  sleep  for  two  nights.  Ordered  the  limb  to  be  slightly  elevated, 
and  lead-water  with  laudanum  applied  to  the  tumour.  A  teaspoonful  of  solu- 
tion of  morphia  procured  him  a  more  comfortable  night  than  he  had  passed  for 
some  time. 

July  23d. — Six  days  have  now  elapsed  since  the  patient's  entrance  into  the 
hospital.  All  signs  of  local  inflammation  have  left  him;  the  skin  has  resumed 
its  natural  appearance;  the  pulsation  is  not  so  strong  in  the  tumour,  which  has 
increased  rapidly  in  size. 

After  a  consultation  with  my  friend  and  colleague  Dr.  Norris,  it  was  deter- 
mined to  apply  a  ligature  to  the  external  iliac  artery  on  the  following  day. 
Ordered  ol.  ricini  §i;  also,  seventy  drops  of  laudanum  to  be  given  two  hours 
before  the  operation. 

July  24th. — Before  the  medical  class,  a  curved  incision,  four  inches  in  length, 
with  its  convexity  directed  towards  Poupart's  ligament,  was  made  through  the 
skin,  commencing  at  a  point  one  inch  and  a  half  above  and  one  inch  on  the 
inner  side  of  the  anterior  superior  process  of  the  ilium,  and  terminating  half  an 
inch  above  the  situation  of  the  external  ring.  The  arteria  ad  cutem  was  divided 
and'  tied.  The  tendon  of  the  external  oblique  was  then  divided  upon  a  director. 
This  brought  into  view  the  lower  edge  of  the  internal  oblique  and  transversalis 
muscles,  which  were  separated  from  Poupart's  ligament  with  the  handle  of  the 
scalpel.  It  was  found  necessary  to  divide  some  of  the  fleshy  fibres  of  the  trans- 
versalis, in  order  to  allow  more  room  for  manipulation,  as  the  tumour  extended 
further  into  the  iliac  fossa  than  we  supposed.  The  peritoneum  was  easily  raised 
up,  and  the  artery  was  felt  beating  distinctly,  but  faintly,  contrasting  forcibly 
with  the  violent  vibration  of  the  tumour.  The  artery,  which  appeared  healthy, 
was  separated  from  the  vein  by  the  finger  nail,  and  a  round  silk  ligature  was 
applied  with  great  facility,  by  means  of  the  excellent  aneurismal  needle  invent- 
ed by  Professor  Gibson  of  this  city.  The  ligature  was  applied  as  high  as  pos- 
sible, so  as  to  allow  sufficient  space  for  the  formation  of  a  coagulum  above  the 
epigastric  artery,  and  both  ends  of  the  ligature  were  allowed  to  remain  hanging 
from  the  wound,  to  serve  as  a  drain.  The  pulsation  of  the  tumour  was  imme- 
diately arrested.  '  The  lips  of  the  wound  were  brought  together  by  two  strips  of 
adhesive  plaster,  and  dressed  with  lint  spread  with  cerate.  The  patient  made 
no  complaint,  during  the  operation,  which  occupied  eighteen  minutes,  but  at  its 
termination,  his  countenance  assumed  great  distress  and  anxiety.  He  was  car- 
ried to  his  bed;  his  limb  slightly  elevated.  The  pulse  before  the  operation  was 
eighty;  immediately  afterwards  seventy-six;  the  thermometer  ninety-four,  being 
the  hottest  day  of  the  season. 

1  o'clock. — Toes  of  right  foot  cold  and  moist;  the  rest  of  the  limb  warm. 
Two  hours  afterwards,  the  coldness  extended  up  to  the  instep;  temperature  of 
both  limbs  the  same;  pulse  sixty-six. 

6  o'clock,  P.  M. — Pain  of  the  whole  limb;  florid;  pulse  seventy-four;  skin 
moist;  thirst;  no  extension  of  coldness  above  instep,  where  the  sensibility  is 
very  obtuse.  Ordered  sol.  morph.  ^ij;  iced  barley  water.  Foot  enveloped  in 
carded  wool. 

Sunday,  11  A.  M. — Slept  well  for  two  hours  and  awoke  in  a  fright;  pain  of 
groin  intensely  severe;  hot  fomentations,  and  sol.  morph.  ^ij,  gave  much  relief 
— this  morning  the  pain  is  moderate;  pulse  seventy-six;  temperature  of  room 
eighty-eight— between  toes  of  right  foot  eighty-six— right  thigh  ninety-six — left 
thigh  ninety-three.     Ordered  oat-meal  gruel  and  toast-water. 

10  P.  M. — Pain  occasionally  darts  through  the  tumour — same  relative  diflfer- 
ence  of  heat  as  in  the  morning.     Ordered  sol.  morph.  ^i. 

26th,  11  A.  M.— Slept  well  the  whole  night.  Pulse  seventy;  skin  moist; 
expression  natural;  difference  of  temperature  still  in  favour  of  right  limb;  sen- 
sibility of  the  limb  improving,  but  less  at  the  anterior  and  inner  side  of  the 
thigh.    The  warmth  of  the  foot  has  returned  as  low  as  the  toes. 


252  American  Intelligence.  [July 

27th. — Slept  well;  both  limbs  of  same  temperature;  sensibility  natural  every- 
where, with  the  exception  of  last  phalanx  of  right  toes,  which  remains  cold.  A 
small  red  spot  at  the  inner  side  of  patella  is  very  painful,  prominent  and  soft; 
the  tumour  is  also  painful  and  inflamed.  Ordered  evaporating  lotion;  sol. 
morph.  5i. 

28th. — No  sleep;  urination  frequent  during  yesterday,  and  every  fifteen  mi- 
nutes during  the  night;  knee  less  painful,  also  the  tumour,  which  is  now  evi- 
dently smaller;  the  skin  wrinkling  and  pale.  Ordered  flaxseed  tea  and  a  large 
cataplasm  over  pubic  region. 

29th. — Passed  a  comfortable  night;  has  urinated  but  twice  since  yesterday; 
feels  perfectly  well,  with  the  exception  of  some  uneasiness  of  right  limb.  Exa- 
mined the  wound  which  is  suppurating  freely.  Two-thirds  of  the  incision  have 
united  by  the  first  intention.  Left  the  wound  open,  as  it  is  closing  too  rapidly, 
and  made  use  of  a  simple  dressing.  The  ligature  of  the  superficial  artery  came 
away. 

No  dejection  since  the  operation.  Ordered  a  common  enema,  which  pro- 
duced a  copious  and  healthy  evacuation. 

August  3d. — Wound  healthy;  the  tumour  diminishes  in  size  and  is  firmer; 
the  oedema  of  limb  entirely  gone. 

The  patient  continued  to  improve  without  any  unpleasant  symptoms;  the  aneu- 
rism becoming  smaller  and  firmer  till  August  the  24th,  thirty  days  after  the 
operation,  when  the  ligature  came  away,  having  a  large  loop.  The  wound  is 
now  closed  with  the  exception  of  the  point  whence  the  ligature  issued. 

September  15th. — The  wound  not  yet  closed;  probed  it,  and  found  a  sinus  ex- 
tending an  inch  and  a  half  in  depth.  Enlarged  the  sinus,  filled  it  with  lint,  and 
applied  a  poultice. 

22d. — Wound  cicatrized,  tumour  lessening  daily  and  quite  firm. 
SOth. — Tumour  half  of  its  former  size.     The  patient  walks  about  his  room, 
and  can  bear  his  whole  weight  upon  the  affected  side. 

November  24th. — Discharged  from  the  hospital;  is  able  to  return  to  his  work. 
The  tumour  is  now  about  the  size  of  a  walnut. 

A  month  afterwards  came  to  see  me,  preparatory  to  his  going  to  sea  as  mate 
of  a  vessel,  perfectly  restored. 

Remarks. — Owing  to  the  rapid  progress  of  the  aneurism,  it  was  not  deemed 
proper  to  apply  pressure  above  the  tumour  with  a  view  of  dilating  the  col- 
lateral branches,  as  recommended  by  several  eminent  surgeons;  and  it  may  be 
well  questioned  whether  the  benefit  resulting  from  dilatation  of  the  vessels  which 
are  to  nourish  the  limb  will  ever  compensate  for  the  greater  danger  incurred  by 
an  increase  of  the  tumour  and  inflammation  of  the  surrounding  tissues.  The 
same  reasons  may  be  urged  against  the  recommendation  to  promote  a  cure  by 
pressure  over  the  tumour;  as  was  practically  exemplified  in  a  case  of  inguinal 
aneurism  reported  by  Dr.  Post  in  the  Amer.  Med.  and  Physical  Register,  (New 
York)  vol.  iv,  where  the  patient,  apprehending  more  from  an  operation  than  from 
the  disease,  refused  the  application  of  a  ligature. 

His  surgeon  then  directed  the  application  of  a  compress  and  bandage  to  keep 
up  a  constant  and  moderate  pressure  upon  the  tumour.  Under  this  treatment  the 
aneurism  diminished  for  a  time,  but  then  increased  rapidly,  while  severe  pain 
and  considerable  local  inflammation,  and  tumefaction  of  the  upper  part  of  the 
thigh  supervened.  These  symptoms  were  finally  relieved  by  a  removal  of  their 
cause,  and  a  resort  to  cold  applications  and  evacuants.  When  the  patient  at  last 
submitted  to  an  operation,  it  was  found  impracticable  to  separate  the  peritoneum 
— which  is  ordinarily  so  easy — owing  to  the  adhesions  that  had  taken  place  be- 
tween that  membrane  and  Poupart's  ligament  from  the  previous  inflammation. 
The  surgeon  was  obliged  to  cut  through  the  peritoneum  in  order  to  apply  the 
ligature;  consequently,  the  patient  was  exposed  to  the  additional  hazard  of  in- 
flammation of  that  membrane.  Fortunately,  the  termination  of  the  case  was 
favourable.  ; 

The  next  point  of  consideration  was  the  propriety  of  applying  one  ligature    ' 
or  two.     Owing  to  repeated  failures  when  but  one  ligature  is  applied,  some  mo- 


1842.]  America^,  Intelligence.  253 

dern  surgeons  have  recommended  a  return  to  the  old  method  of  securing  the 
artery  above  and  below  the  tumour.  Whether  the  greater  certainty  of  prevent- 
ing a  return  of  the  circulation  by  these  means  makes  up  for  the  increased  danger 
of  a  double  operation,  can  only  be  tested  by  statistical  information  which  is  not 
easily  obtained,  this  difficulty  resulting  from  the  small  number  of  cases  that 
have  occurred  in  the  practice  of  any  one  surgeon  or  at  any  one  place  and  from 
the  suppression  of  unsuccessful  cases.  With  a  view  of  contributing  to  the 
amount  of  knowledge  bearing  on  this  question,  the  experience  of  this  city  is 
here  given.  The  ligature  of  the  external  iliac,  for  aneurism  of  the  femoral 
artery,  has  been  successfully  performed  by  Dr.  Dorsey  in  1811;  by  Dr.  Ran- 
dolph in  1825,  and  in  the  third  case  by  Professor  Horner  at  the  Blockley  Hos- 
pital, where  two  ligatures  were  applied  and  the  sac  opened.  The  particulars 
of  this  case,  the  termination  of  which  was  unfavourable,  will  be  soon  reported. 
The  shortness  of  this  catalogue  shows  the  extreme  rarity  of  the  disease.  Re- 
collecting that  even  a  return  of  the  pulsation  does  not  necessarily  prevent  the 
formation  of  coagula  and  a  final  cure,  it  appears  to  be  most  prudent  to  trust  to 
one  ligature  in  aneurisms  of  the  first  class,  whilst  in  smaller  vessels,  where  there 
is  but  little  danger  of  a  fatal  termination,  two  ligatures  will  more  certainly  pre- 
vent a  return  of  the  circulation. 

It  has  not  occurred  in  any  prior  case  that  I  have  noticed,  that  the  tempera- 
ture of  the  limb  operated  upon  has  been  greater  than  that  of  the  sound  limb, 
immediately  after  the  operation.  This  difference  of  heat  in  favour  of  the  unsound 
limb  continued  for  three  days,  nor  was  it  at  any  time  reversed.  Dr.  Neil,  who  was 
residing  at  that  time  in  the  hospital,  kept  an  exact  observation  of  these  facts,  as 
well  as  myself.  They  exemplified  in  a  remarkable  degree  the  importance  of  the 
capillary  circulation,  and  the  power  of  the  collateral  branches,  to  compensate  for 
obliteration  of  the  main  artery;  and  they  would  lead  us  to  suspect  that,  in  this 
case,  the  impetus  of  the  circulation  had  been  diminished  by  a  partial  formation 
of  coagula.  This  would  explain  why  we  were  unable  to  reduce  the  size  of  the 
tumour  when  we  arrested  the  pulsation  by  pressure  upon  the  aorta,  and  the  sin- 
gular feebleness  of  the  pulsation  in  the  artery  which  was  remarked  when  the 
ligature  was  applied. 

With  the  exception  of  the  irritation  of  the  bladder  on  the  fifth  day,  no  unplea- 
sant symptoms  of  any  kind  occurred  during  the  whole  course  of  treatment,  which 
was  unnecessarily  prolonged  by  the  ligature  not  having  been  tied  sufficiently 
tight.  This  was  manifested  by  the  large  size  of  the  loop,  and  it  satisfactorily 
accounts  for  the  retention  of  the  ligature  for  thirty  days. 

Excision  of  a  large  Tumour  upon  the  Nech,  By  R.  D.  Mussev,  M.  D.,  Prof. 
Surgery  in  the  Medical  College  of  Ohio. — In  December,  1841,  I  was  consulted 
by  Mr.  Jas.  C.  M'Dowell,  setat.  34,  of  Mt.  Carmel,  Wabash  Co.,  Illinois,  on 
account  of  a  large  tumour  on  the  right  side  of  his  neck,  and  received  from  him 
the  following  account  of  it. 

The  tumour  commenced  eighteen  years  ago,  in  the  form  of  a  lump,  below  the 
tip  of  the  ear,  of  the  size  of  a  hazelnut,  which  was  painful,  and  which,  on  that 
account,  was  thought  to  be  mumps.  The  pain  subsided  in  a  few  days,  but  the 
swelling  and  hardness  remained.  From  that  time  the  progress  of  the  tumour 
was  slow,  and  almost  always  without  pain,  till  within  the  last  eighteen  months, 
during  which  time  he  had  experienced  a  great  deal  of  pain  in  the  ear  and  on  the 
side  of  the  face.  In  1828,  between  five  and  six  years  after  the  first  appearance 
of  the  disease,  and  when  the  tumour  was  about  the  size  of  a  hen's  egg^ 
he  came  to  Cincinnati  and  took  advice  from  the  Professor  of  Surgery  in  the 
Medical  College  of  Ohio,  who  declined  operating,  saying,  "  that  the  carotid 
artery  must  first  be  tied,  or  the  extraction  of  the  tumour  would  prove  fatal  in  a 
few  minutes;  and  besides,  the  right  side  of  the  face  would  be  palsied  by  the 
division  of  an  important  nerve,"  &c. 

The  tumour  presented,  at  the  time  above  mentioned,  viz.  Dec.  1841,  the 
following  appearances. — It  was  nearly  hemispherical  in  form  with  some  tubero- 
sities, extending  from  the  lower  part  of  the  concha  of  the  ear,  which  it  crowded 
No.  VH.— July,  1842.  22 


254  American  Intelligence.  [J"iy 

a  little  upward,  to  within  an  inch  and  three  quarters  of  the  clavicle,  and  antero- 
posteriorly  from  the  anterior  border  of  the  cervical  portion  of  the  trapezius,  to 
within  two  inches  of  the  median  line  upon  the  chin,  coverings  part  of  the  larynx 
and  trachea,  and  a  large  portion  of  the  lower  jaw.  A  line  stretched  from  the 
anterior  to  the  posterior  edge  of  the  base  of  the  tumour,  over  its  apex  or  pole, 
measured  ten  inches;  and  its  circumference  at  the  base  was  seventeen  inches. 
The  sterno-cleido-mastoid  muscle  was  put  in  a  state  of  tension  upon  the  back 
part  of  the  tumour,  and  seemed  adherent  to  it.  This  large  mass  possessed  a 
good  degree  of  solidity,  had  no  uncommon  sensibility  to  the  touch,  could  be 
made  to  glide  slightly  in  the  antero-posterior  direction,  showing  that  it  did  not 
involve  the  deep  and  large  vessels,  and  most  important  nerves  of  the  neck:  the 
integument  covering  it  was  healthy  looking. 

I  decided  upon  the  practicability  of  its  removal,  and  put  the  patient  upon  a 
farinaceous  diet,  with  water  only  for  his  drink;  and  on  the  11th  of  January, 
1842,  in  the  presence  of  several  professional  gentlemen,  and  a  few  friends  of 
the  patient,  proceeded  to  the  operation.  The  integuments  and  platysma  w^ere 
divided  by  a  vertical  and  a  horizontal  incision  crossing  each  other  at  right  angles 
upon  the  pole  of  the  tumour;  the  flaps  were  carefully  raised,  and  the  mass  slow- 
ly disengaged  from  the  condensed  cellular  bands  which  shot  from  the  neigh- 
bouring parts,  and  from  the  mastoid  muscle,  a  portion  of  the  attenuated  edge  of 
which  was  removed.  Some  difficulty  was  found  and  a  good  deal  of  pain  pro- 
duced in  detaching  it  from  the  infra-auricular  and  infra-maxillary  tissues,  but  no 
important  blood-vessel  was  wounded  or  muscle  mutilated,  except  the  mastoid; 
nor  nerve  injured,  except  a  descending  branch  of  the  facial,  by  which  a  slight 
displacement  was  given  to  the  integuments  of  the  chin.  The  angle  of  the  mouth 
kept  its  natural  position.  There  was  less  than  a  pint  of  blood  lost,  and  the 
patient,  though  somewhat  faint  for  a  short  time  during  the  operation,  causing  a 
little  delay,  had  so  far  rallied  as  to  be  comfortable  during  the  application  of  the 
dressings,  and  after  he  was  carried  to  his  bed.  The  following  night  he  was 
restless  and  had  considerable  pain  with  irritative  fever,  which  were  soothed  by 
an  anodyne  dose  with  spiritus  mindereri. 

After  the  first  night  Mr.  M'Dowell  was  comfortable — the  wound  healed  kind- 
ly, and  in  four  weeks  he  left  the  city  to  visit  his  friends.  Within  the  last  few 
days  we  learn  by  a  gentleman  directly  from  his  residence,  that  he  is  in  sound 
health  and  good  spirits. 

For  the  purpose  of  safely  extracting  large  tumours  from  the  neck,  it  can 
rarely  be  necessary  to  ligate  the  carotid  artery  as  a  preparatory  step.  By  car- 
rying the  dissection  close  to  the  morbid  growth  but  little  risk  is  incurred,  unless 
in  the  fungoid  growths,  which  sometimes  completely  encircle  large  vessels  and 
important  nerves;  and  with  these  there  is  but  little  encouragement  for  an  ope- 
ration. 

The  slow  progress  of  the  tumour,  together  with  its  solidity  and  freedom  from 
irritation,  served  to  mark  it  as  a  morbid  structure  of  mild  character;  and  yet 
from  the  frequent  and  strong  pains  induced  by  mechanical  tension  of  sentient 
nerves  in  its  neighbourhood  during  the  last  year  and  a  half,  it  might  ultimately 
have  kindled  up  an  action,  the  result  of  which  would  be  obstinate  or  incurable 
ulceration;  but,  as  it  is,  the  operation  will  almost  certainly  be  followed  by  entire 
exemption  from  the  disease. 

The  superficial  portion  of  the  parotid  gland  was  not  to  be  observed  distinct 
from  the  tumour;  indeed  there  was  no  obvious  trace  of  any  part  of  it  remaining. 
Like  most  tumours  of  slow  growth,  occupying  the  site  of  the  parotid,  it  com- 
menced, in  all  probability,  in  a  lymphatic  gland,  and  by  pressure  during  its 
progressive  and  protracted  enlargement,  it  had  caused  an  entire  absorption  of  so 
much  of  the  parotid  as  came  in  its  way. —  Western  Lancet^  May  1842. 

Thymic  Enlargement. — Dr.  W.  C.  Roberts,  in  an  interesting  article  on  this 
subject,  in  the  New  York  Medical  Gazette,  (April  6lh  and  13th,  1842,)  gives  the 
following  statements  relative  to  the  weight  and  size  of  the  Thymus  gland. 

"  I  am  indebted  to  Dr.  Archer  for  the  two  following  measurements. 


1842.] 


American  Intellis^ence.  255 


"1st.  Child  at  full  time,  had  only  breathed  a  few  times,  length,  21  inches: 
width,  2^  inches;  weig'ht,  168  grains. 

*'2d.  A  child  weighing  'plump'  12  pounds,  of  uncommon  development,  sup- 
posed to  be  about  two  days  old,  which  died,  as  is  supposed,  from  exposure. 
Length,  2 J  inches;  width,  1^  inches;  weight,  ^iiiss.  or  210  grains.  It  was 
exceedingly  full,  owing  to  the  presence  of  a  great  quantity  of  thick,  viscid  fluid, 
and  of  a  bright  red  colour.  I'he  reader  will  please  to  observe  that  in  this  very 
fair  case,  to  estimate  the  normal  weight  of  the  gland  at  birth,  it  weighed  half  a 
drachm  less  than  the  average  quantity  stated  by  Sir  A.  Cooper. 

"3d.  Seven  months  foetus.  Length  (extreme)  3  inches,  from  the  tip  of  the 
longest  cornu,  to  the  tip  of  the  longest  lobe;  width,  1^  inches;  weight,  84  grains. 
It  was  very  flat,  and  of  a  pale  rose  colour. 

*'To  the  attentive  kindness  of  Dr.  Darling,  late  of  the  Bellevue  Almshouse, 
I  add  the  followinsf  table: — 


1. 

Stillborn. 

Length 

,  n  in. 

Width 

1t\ 

in. 

Weight, 

100  grs. 

2. 

do. 

(( 

n 

(( 

n 

ii, 

176 

3. 

do. 

Ik 

n 

(» 

n 

(( 

196 

4. 

do.  twins. 

It 

3t\ 

(i 

n 

a 

133 

5. 

2  hours  old. 

(i 

n 

(( 

n 

(( 

200 

6. 

56  hours  old. 

(( 

ii 

(( 

lA 

(( 

60 

(died  of  Cyanosis!) 

7. 

5  days  old. 

(( 

n 

u 

IrV 

i( 

47 

(Supposed"  to  b( 

3  an  8  month 

s  child.) 

8. 

7       » 

(( 

2^ 

(t 

If^ 

a 

56 

"In  addition  to  the  11  cases  thus  recorded,  the  maximum  weight  of  which  is 
210  grains,  and  that,  connected  as  I  think,  with  an  hypertrophied  state  of  the 
organ,  I  liave  reported,  in  the  11th  No.  of  this  Journal,  five  others,  the  greatest 
weight  of  any  of  those  being  (at  5  months)  223  grains.  In  the  same  Journal, 
also,  I  have  mentioned  a  sixth  which  appeared  to  me  both  extremely  hypertro- 
phied and  inflamed,  which  weighed  six  drachms.  The  results  of  these  16  mea- 
surements, and  particularly  that  of  the  second  case,  sent  me  by  Dr.  Archer,  do 
not  tend  to  support  the  idea  that  the  thymus  gland,  at  birth,  weighs  240  grains^ 
as  stated  by  Hangstedt,  Cooper  and  others.  1  am  much  more  disposed  to  con- 
cur with  the  'reviewer  of  Hangstedt's  paper  in  the  Medico-Chirurg.  Review, 
April,  1834,  that  its  weight  at  birth  is  from  120  to  180  grains.'  " 

Dr.  Roberts  also  relates  the  following  case,  in  which  he  considers  that  the 
fatal  result  was  due  to  enlargement  of  the  thymus,  and  which  we  transfer  to  our 
pages,  as  everything  calculated  to  in  any  degree  elucidate  the  actual  influence 
of  that  state  of  the  gland  and  the  symptoms  to  which  it  gives  rise,  is  worthy  of 
attention,  though  we  must  confess  that  we  cannot  regard  the  case  in  the  same 
light  that  Dr.  R.  does. 

"  March  18,  1842.  Was  called  to  see  Henry  Duffy,  coloured,  aged  two  years 
and  one  month.  He  was  lying  on  his  mother's  lap  somewhat  exhausted  appa- 
rently, by  vomiting,  during  the  previous  half  hour.  The  skin  was  not  very  hot 
nor  the  circulation  hurried,  and  he  was  perfectly  rational.  On  being  raised  to 
the  erect  position,  the  vomiting  was  immediately  renewed.  Some  mucous  fluid 
and  some  particles  of  ham,  were  among  the  matters  vomited.  The  history 
which  I  received  of  this  case  at  the  time  and  subsequently,  was  as  follows.  He 
was  stout,  and  had  been  well  all  winter.  Up  to  this  time  he  had  had  nothing 
of  a  bowel  complaint;  his  stools  had  been  figured  and  healthy,  and  he  had  had 
two  of  that  character  on  the  day  that  I  saw  him.  He  had  never  been  known  to 
have  any  fits,  or  strangling,  was  not  short  breathed,  never  crowed,  or  held,  or 
caught  his  breath,  and  had  never  been  noticed  to  assume  any  chancre  of  colour. 
The  only  thing  which  could  be  recollected  was,  that  occasionally  he  made 
repeated,  successive  and  painful  attempts  at  swallowing. 

"For  a  week  past,  succeeding  the  death  of  a  sister,  he  had  appeared  worri- 
some and  dispirited,  had  a  slight  catarrh,  and  evinced  a  constant  disposition  to 
be  out  of  doors  all  the  time.     He  awoke,  on  the  day  I  saw  him,  as  well  as 


256  American  Intelligence,  [July 

usual,  breakfasted  on  some  tea  and  a  small  piece  of  fried  ham.  In  the  forenoon 
he  also  ate  a  small  piece  of  raw  carrot.  About  noon  he  went  out  with  his  mo- 
ther; returned  in  half  an  hour,  and  then  pointed  to  his  throat,  saying,  "  mammy 
— hurts  me,"  soon  after  which  he  vomited  and  ejected  the  carrot.  After  this  he 
went  a  little  distance  to  a  grocery  store,  and  on  his  return  vomited  again,  and 
continued  to  do  so  during  half  an  hour,  when  I  was  called  to  him.  A  gentle 
emetic  was  now  given  him.  At  half  past  four,  P.  M.,  he  seemed  much  the 
same.  The  emetic  had  operated,  and  he  had  one  evacuation  wholly  mucous, 
and  of  extreme  fetor.  Soon  after  I  left  he  began  to  worry  and  call  for  drink 
repeatedly;  thebreathing  become  quick,  the  heart  began  (so  his  mother  says)  to 
beat  rapidly,  and  he  grew  very  hot.  Such  was  his  condition  at  six  P.  M.,  when 
I  saw  him.  He  was  then  asleep,  but  awoke  on  my  entrance  perfectly  rational, 
and  asked  for  drink,  for  which,  as  he  had  been  taught,  he  immediately  returned 
his  thanks.  Five  grains  of  calomel,  to  be  followed  by  senna  inf.,  was  ordered 
with  tepid  sponging,  the  pediluvium,  &c.  At  12  M.,  I  was  again  sent  for,  and 
told  he  was  dying.  He  was,  though  perfectly  intelligent,  evidently  much  ex- 
hausted, occasionally  closing  his  eyes  and  opening  them  again,  and  asking  for 
drink  which  he  consumed  greedily.  I  could  discover  no  symptom  indicative  of 
cerebral  disease;  the  respiratory  murmur  was  present  in  both  lungs,  and  the 
belly  soft  and  not  tympanitic  or  tender;  the  action  of  the  heart  was  very  rapid 
and  diffused,  the  pulse  also  rapid,  but  feeble;  pulsation  was  very  distinct  in  epi- 
gastrio,  and  the  skin  hot.  The  respiration  56  (I  think),  abdominal,  but  silent, 
or  at  least,  not  loud.  After  the  most  careful  consideration,  I  found  myself 
utterly  at  a  loss  to  form  an  idea  of  the  nature  of  his  case,  but  imagined  that 
some  disease  existed  within  the  intestines.  An  enema  was  given  which  brought 
away  only  some  of  the  before-mentioned  very  fetid  mucus,  which  exactly  resem- 
bled that  expectorated  in  bronchitis.  There  was  no  trace  of  bile  or  faeces. 
There  had  been  no  more  vomiting  since  half  past  four  P.  M.  I  blistered  the 
belly  and  ordered  wine  whey,  and  spir.  minder,  alternately,  and  left  him  at  half 
past  two  A.  M.  of  the  19th.  The  rapid  action  of  the  heart,  and  heat  of  the 
skin  continued,  as  I  am  told,  to  the  last,  and  he  continued  asking  for  drink  till 
an  hour  and  a  half  before  he  died.  In  the  course  of  this  period,  he  had  four 
short  convulsions  (lasting  half  a  minute)  and  after  the  occurrence  of  the  first  of 
these,  he  did  not  succeed  in  speaking  intelligibly,  though  he  repeatedly  tried, 
and  seemed  to  have  his  senses  perfectly,  and  to  know  all  around  him.  In  the 
intervals  between  the  fits,  his  breathing  was  very  rapid  and  could  be  heard  into 
an  adjoining  room,  and  he  had  occasional  slight  twitchings  of  his  whole  body. 
A  curious  circumstance  is  yet  to  be  mentioned.  A  little  before  he  died  he 
attempted  to  raise  himself  in  bed,  and  being  assisted,  looked  round  and  put  his 
hand  to  his  mouth,  as  if  wanting  to  eat.  His  mother  then  gave  him  some 
pieces  of  cracker,  which  he  chewed  and  swallowed  ravenously.  Twice  he  put 
a  piece  into  his  mouth  with  his  own  hands.  Thus  he  continued  swallowing 
eagerly  everything  that  was  given  him,  until  just  before  he  died,  which  was  at 
half  past  five.  During  this  time  his  eyes  were  open,  though  he  closed  them 
occasionally,  his  breathing  was  short,  and  his  heart  beat  violently.  And  his 
mother,  an  intelligent  woman,  believes  that  his  faculties  remained  unimpaired 
to  the  last.  Latterly  he  moaned  a  good  deal,  had  a  little  mucous  rattle,  and  I 
suspect,  died  rather  abruptly,  having  lived  17^  hours  from  the  period  of  his 
attack. 

"I  have  been  particular  in  relating  these  apparently  trivial  circumstances,  in 
order  to  show  that  there  existed  no  ground  for  any  suspicion  of  cerebral  diffi- 
culty. On  this  account  I  did  not  think  it  necessary  to  examine  the  brain  at  the 
autopsy,  which  was  made  in  the  course  of  the  day,  and  in  which  I  was  kindly 
assisted  by  Dr.  James  McOune  Smith.  On  opening  the  belly,  we  found  the 
spleen,  bladder  and  kidneys  healthy.  The  liver  had  also  a  healthy  appearance, 
save  that  on  its  upper  surface  there  were  some  tawny  spots.  The  gall-bladder 
was  excessively  distended  with  dark  olive  bile.  The  mucous  membrane  of  the 
stomach  was  of  a  light  sienna  colour,  perfectly  free  from  any  trace  of  redness, 
and  the  mucous  membrane  of  the  intestines  appeared  sound  throughout  in  colour' 


1842.]  American  Intelligence.  257 

and  consistence.  But  from  the  lower  end  of  the  ileum  to  the  termination  of  the 
rectum,  the  mucous  follicles  in  a  state  of  hypertrophy,  though  not  ulcerated, 
existed  to  an  extent  which  I  have  never  before  witnessed,  and  many  of  Peyer's 
plates,  of  varyipig  sizes,  were  enlarged  and  mamillated,  as  if  made  up  of  a  con- 
geries of  mucous  follicles.  I  really  believe  that  every  mucous  follicle  in  the 
large  intestines  was  enlarged,  yet  there  were  no  traces  of  vascularity  on  the 
surface  of  the  membrane,  nor  w^ere  the  mesenteric  vessels  congested.  The 
glands  were  much  enlarged,  but  firm. 

"The  heart  and  lungs  I  removed,  and  submitted  to  be  examined  by  my  friend 
Dr.  Swett,  and  I  have  his  authority  for  saying,  after  a  most  careful  inspection, 
that  the  lungs  and  bronchi  were  perfectly  healthy^  the  foramen  ovale  was  entirely 
impervious;  the  left  ventricle  of  the  heart  was  slightly  hypertrophied,  its  walls 
being  half  an  inch  in  thickness,  but  no  other  abnormal  condition  of  it  existed. 
The  Thymus  Gland  he  considered  to  be  at  least  twice  its  natural  size.  It  en- 
tirely covered  the  anterior  surface  of  the  heart  to  within  one  quarter  of  an  inch 
of  its  apex,  having  but  one  cornu  (right),  which  extended  up  for  an  inch  and  a 
half  upon  the  trachea.  The  thymus  adhered  very  firmly  to  the  pericardium. 
Its  extreme  length  was  four  and  a  half  inches;  its  breadth,  two  and  a  half  inches; 
it  weighed  285  grains. 

"Excluding  the  idea  that  this  child  died  of  cerebral  disease,  or  pneumonia, 
and  that  the  heart  was  sufficiently  diseased  to  have  been  the  cause  of  death,  we 
are  naturally  led  to  inquire  into  the  cause  of  this  suddenly  fatal  result.  It  had, 
it  is  true,  an  extreme  development  of  the  mucous  follicles,  but  this  must  have 
existed  for  some  considerable  time  before,  and  the  symptoms  which  accompa- 
nied the  attack  were  certainly  not  those  of  follicular  enteritis.  Is  it  not  then 
reasonable  to  conclude  that  the  indigestion  of  the  morning's  meal  induced  a  gas- 
tric irritation  which  was  extended  by  sympathy  to  the  heart;  and  that  then  the 
thymus,  which  had  undergone  since  the  time  of  birth  no  diminution,  and  was 
consequently,  for  the  age  of  the  child,  in  a  state  of  hypertrophy,  produced  its 
peculiar  obstruction,  and  that  death,  with  its  usual  phenomena,  resulted  there- 
from? The  gland  in  this  case,  compared  with  others,  was  small.  It  was  45 
grains  larger  at  two  years,  than  at  birth,  and  though  I  do  not  contend  that  it 
was  either  congenitally  enlarged,  nor  that  it  had  grown  much  morbidly  after 
birth,  I  conceive  that  the  case  gives  support  to  the  opinion  I  formerly  expressed, 
that  the  not  undergoing  diminution  from  the  natural  size  at  birth,  exposes  the 
child  to  danger  at  any  subsequent  period.  Notwithstanding  its  comparatively 
small  weight  and  breadth,  the  heart  was  as  completely  covered  by  it  as  in  any 
case  I  have  seen,  and  probably,  therefore,  its  functions  as  much  interfered  with. 
The  heat  of  skin  which  the  child  had,  is  mentioned  neither  by  Hoffman,  nor 
Hamilton;  but  it  existed  in  my  first,  third,  and  fourth  cases.  The  rapid  respira- 
tion mentioned  by  me,  in  my  first  and  second  cases,  and  considered  by  Dr.  Lee, 
to  be  '  too  common  in  infants,  to  be  viewed  as  diagnostic  of  anything  in  parti- 
cular,' which  so/ora6/3/ struck  Doctors  Hamilton  and  Hoffman  (see  their  cases) 
existed  in  this  case,  and  was  really,  almost  the  only  morbid  symptom;  certainly 
the  chief  alarming  one.  It  led  me,  in  thinking  the  case  over  afterwards,  to 
entertain  the  probability  that  it  might  prove  to  be  a  case  of  thymic  asthma,  so 
strongly,  as  to  induce  me  to  say  so  to  Dr.  Smith  before  making  the  autopsy. 
It  led  Dr.  Hoffman  to  his  diagnosis;  in  Dr.  Hamilton's  case  there  were  93 
respirations  in  a  minute;  in  my  second  case  it  was  like  the  quick  pantings  of  a 
dog,  and  attracted  the  attention  of  every  one,  and  therefore,  with  great  deference 
to  the  accomplished  reviewer  of  my  humble  labours,  I  would  suggest  that  there 
is  ''one  thing  in  particular^  of  which  it  may  be  *  diagnostic,'  and  venture  to 
repeat  my  previous  assertion,  that  '  the  sudden  invasion  of  extraordinarily  rapid 
breathing,  and  of  forcible  pulsation  of  the  heart,  in  a  child  previously  healthy, 
or  labouring  under  slight  bronchitis,  &c.  only,  ought  to  lead  us  to  suspect  the 
existence  of  an  enlarged  thymus  gland.'  Speaking  of  his  patient,  Dr.  Hamilton 
says  '  that  he  swallowed  water  freely  fifteen  minutes  before  he  died  and  seemed 
conscious.^  " 


258  American  Intelligence.  [July 

BlepharnplasHc  operation  for  Ectropion. — Dr.  A.  C.  Post  relates,  in  the  New 
York  Med.  Gaz.  Jan.  19th,  1842,  an  interesting  case  of  successful  operation 
for  ectropion  from  a  burn. 

The  subject  of  it  was  a  boy  seven  years  of  age,  who  had  the  left  side  of  his 
face  badly  burned  about  three  years  ago,  in  consequence  of  his  clothes  taking 
fire.  When  the  sore  healed,  there  was  left  a  hard  wrinkled  cicatrix  of  a  red- 
dish colour,  drawing  down  the  lower  lid,  and  occasioning  an  eversion  of  its 
whole  internal  surface.  The  conjunctiva  of  the  lid  which  was  thus  exposed  to 
the  air,  was  dry,  and  resembled  in  its  appearance  the  integument  covering  the 
vermilion  border  of  the  lips.     The  margin  of  the  lid  was  much  elongated. 

On  the  5th  June,  1841,  at  2  P.  M.,  Dr.  P.  performed  the  following  opera- 
tion, assisted  by  doctors  J.  Kearny  Rodgers,  Blakeman,  Trudeau  and  Buel. 

I  first  made  an  incision  immediately  below  the  everted  lid,  by  which  I  de- 
tached it  from  the  cheek.  I  then  cut  out  out  a  V  shaped  piece  from  the  lid,  and 
brought  the  edges  of  the  incision  together  with  a  suture,  by  which  the  tarsal 
edge  of.the  lower  lid  was  brought  into  apposition  with  the  corresponding  margin 
of  the  upper  lid,  leaving,  however  a  considerable  chasm  between  the  lower  lid 
and  the  cheek.  I  then  dissected  a  vertical  flap  from  the  integument  covering  the 
anterior  edge  of  the  masseter  muscle,  about  two  inches  in  length  and  five- 
eighths  of  an  inch  in  breadth,  leaving  it  attached  at  its  upper  extremity  by  a 
neck  three-eighths  of  an  inch  in  breadth.  The  flap  was  then  brought  around  so 
as  to  fill  up  the  chasm  between  the  lower  lid  and  the  cheek,  and  was  secured  in 
its  place  by  ten  sutures.  The  sides  of  the  wound  from  which  the  flap  was 
taken,  were  brought  together  and  secured  by  three  sutures,  fortified  by  adhesive 
straps.  The  only  situation  in  which  the  sides  of  the  wound  were  not  brought 
into  contact,  was  at  the  angle  below  the  twist  in  the  neck  of  the  flap.  A  piece 
of  lint  dipped  in  iced  water  was  applied  over  the  wound,  and  directed  to  be  mois- 
tened as  often  as  it  became  dry  or  ivarm. 

8  P.  M.  The  patient  appears  cheerful;  there  is  no  pain  or  swelling  about 
the  wound. 

June  6th.  The  flap  appears  red,  but  there  is  no  pain  or  swelling. 

June  1th.  He  complained  in  the  afternoon  of  some  pain  in  the  wound;  but 
everything  appears  to  be  going  on  favourably. 

June  9th.  Removed  three  of  the  sutures. 

June  10th.  Removed  three  other  sutures.  Union  by  the  first  intention  has 
taken  place  around  the  greater  part  of  the  flap;  but  suppuration  has  occurred  at 
the  extremity  towards  the  nose. 

June  llth.  Removed  all  the  remaining  sutures;  found  that  union  had  taken 
place  throughout  the  whole  wound,  except  at  three  points,  viz.:  the  angle  below 
the  twist  in  the  neck  of  the  flap,  the  junction  of  the  extremity  of  the  flap  with 
the  side  of  the  nose,  and  the  inferior  angle  of  the  part  of  the  wound  from  which 
the  flap  was  taken. 

June  20th.  The  wound  has  healed  throughout  its  whole  extent.  The  ever- 
sion appears  to  be  entirely  cured.  The  patient  has  the  full  power  of  opening 
and  closing  the  lids.  The  twist  at  the  neck  of  the  flap  is  almost  entirely  ef- 
faced: but  the  outer  canthus  is  crowded  somewhat  towards  the  nose,  so  as  to 
make  the  aflTected  eye  appear  smaller  than  the  sound  one. 

Snakebites. — Prof.  Drake,  of  Louisville,  wishes  physicians  to  communicate  to 
him  such  facts  concerning  the  bites  of  our  venomous  snakes,  as  may  have  fallen 
under  their  own  observation,  or  that  of  persons  qualified  to  observe.  He  is  es- 
pecially desirous  of  learning  whether  the  symptoms  produced  by  the  bite  of  the 
rattlesnake,  the  copper-head,  and  the  prairie  rattlesnake,  are  the  same;  whether 
there  is  an  annual  recurrence  of  any  of  these  symptoms;  and  to  what  extent 
confidence  should  be  placed  in  the  efficacy  of  those  native  plants  which  have 
been  recommended  as  antidotes. 

We  invite  the  attention  of  our  readers  to  this  request,  and  hope  that  they  will 
aid  the  cause  of  science  by  communicating  any  facts  in  their  possession  of  the 
kind  desired. 


1842.]  American  Intelligence.  259 

Medical  Schools  of  the  West. — Next  winter,  there  will  be  seven  Medical 
schools  in  operation  in  the  Valley  of  the  Mississippi  and  the  Lakes.  They  be- 
loncr  to  four  States,  as  follows:  In  Kentucky — the  Medical  Department  of  Tran- 
sylvania University,  and  Medical  Institute  of  Louisville;  in  Ohio,  the  Medical 
College  of  Ohio,  and  Willoughby  University  of  Lake  Erie;  in  Missouri,  the 
Medical  Department  of  Kemper  College,  and  the  Medical  Department  of  the 
University  of  St.  Louis;  in  New  Orleans,  the  Medical  College  of  Louisiana. — 
The  Western  Journ.  of  Med.  ^  Surg.  June,  1842. 

Assistant  Surgeons  in  the  Navy. — We  learn  that  of  thirty-two  candidates  lately 
examined  for  assistant  surgeons  in  the  navy,  fifteen  only  passed  the  ordeal. 

The  following  is  the  list  of  the  successful  candidates,  classed  according  to 
their  relative  merits.  1.  Wm.  S.  Bishop;  2.  Samuel  M.  Edgar;  3.  Joseph 
Wilson,  Jr.;  4.  Charles  Eversfield;  5.  E.  K.  Kane;  6.  Edward  Hudson;  7. 
Richard  McSherry;  8.  Wm.  Pitt  Canning;  9.  E.  J.  Bee;  10.  J.  L.  Burtt;  11. 
J.  T.  Barton;  12.'  A.  C.  Holt;  13.  James  Hamilton;  14.  Charles  H.  Oakley; 
15.  R.  N.  Baer. 

Medical  ^Advertising. — We  observe  the  following  article  in  our  cotem- 
porary  the  Medical  Examiner  for  April  9th,  1842. 

"  We  accidentally  noticed  the  subjoined  advertisement  in  a  late  Richmond 
paper: — 

*  Radical  Cure  of  Strictures  of  the  Urethra — Dr. adopts  this  method  of 

informing  persons  labouring  under  Stricture  of  the  Urethra,  that  he  is  success- 
fully treating  that  troublesome  and  loathsome  disease  upon  an  entirely  new  plan 
of  his  own  invention — and  that  he  will  warrant  perfect  and  speedy  cures  in  every 
case — even  the  most  aggravated  and  complex,  which  may  be  confided  to  his 
care. 

iXT*  Consul  tat  ions  with  Dr. — ,  in  cases  of  Stricture,  by  letter  or  other- 
wise, will  be  confidential. 

,  C.  H.,  Va.,  Jan.  8th,  1842.' 

"  Our  readers  will  be  surprised  to  learn  that  thsi  singular  advertisement  pro- 
ceeds from  a  surgeon  of  considerable  eminence,  well  knovt^n  as  a  frequent  con- 
tributor to  the  pages  of  the  American  Journal.  Had  it  not  come  from  one  whose 
example  must  exert  some  influence  upon  the  younger  members  of  the  profession, 
we  should  have  passed  it  without  notice.  As  it  is,  we  think  it  the  duty  of  journ- 
alists to  express  the  general  feeling  of  the  profession  in  justly  condemning  such 
advertisements:  they  are,  to  say  the  least  of  them,  entirely  unprofessional." 

We  do  not  know  who  is  the  Surgeon  alluded  to  in  the  above  notice,  but 
we  must  say  that  we  feel  deeply  mortified  that  any  one  of  our  contributors 
should  have  authorized  the  publication  of  such  an  advertisement  as  the 
above,  and  we  do  not  hesitate  to  avow  our  own  views  on  this  subject  to 
be  in  entire  accordance  with  those  of  our  cotemporary.  Indeed  we  have 
already  expressed  such  opinions  (see  our  No.  for  Oct.  1841,  p.  512)  in 
noticing  some  resolutions  adopted  by  the  East  of  England  Association;  and 
as  further  evidence  that  these  are  the  general  sentiments  of  the  profession, 
we  call  attention  to  the  following  section  of  the  constitution  of  the  recently- 
formed  association  in  New  York  for  the  relief  of  the  widows  and  orphans 
of  medical  men. 

"  Sec.  8.  No  person  shall  be  admitted  a  member  of  this  society  who  publicly 
advertises  any  medicine  as  a  secret,  or  who  publicly  advertises  to  cure  any  dis- 
ease." 

Medical  College  of  Ohio. — The  trustees  of  this  school  have  given  notice  that 
the  chair  of  Theory  and  Practice  of  Medicine  having  become  vacant  by  the 
resignation  of  Prof.  Kirtland,  they  will  receive  applications  for  the  same  until 


260  American  Intelligence. 

the  15th  of  July.     Letters  on  the  subject  to  be  directed  to  D.  K.  Este,  Esq. 
Cincinnati. 

A  popular  Treatise  on  Vegetable  Physiology:  with  numerous  wood  cuts. — This 
volume  was  published  in  London  under  the  auspices  of  the  "Society  for  the 
Promotion  of  Popular  Instruction,"  and  it  has  been  republished  in  this  country 
by  Messrs.  Lea  &  Blanchard  in  consequence  of  their  "feeling  assured  that  it 
will  be  found  sufRciently  simple  in  its  character,  and  clear  in  its  explanations, 
to  be  regarded  as  an  elementary  treatise,  adapted  to  those  who  have  no  previous 
knowledge  of  the  subject;  whilst  its  systematic  arrangement,  and  the  scientific 
value  of  the  principles  laid  down  in  it,  render  it  an  excellent  introduction  to 
more  comprehensive  works  on  the  same  subject.  The  general  reader,  who  seeks 
no  more  than  entertainment  or  recreation,  will  find  it  in  this  volume,  in  the 
copious  illustrative  facts  and  interesting  collateral  information,  with  which  it 
abounds;  whilst  to  the  Agriculturist,  the  Gardener,  and  the  Domestic  Econo- 
mist, it  supplies  principles  and  practical  applications  of  great  importance." 

Philadelphia  College  of  Pharmacy. — Dr.  Robert  Bridges  has  been  appointed 
Prof,  of  Chemistry  in  this  school,  in  the  place  of  Wm.  R.  Fisher  resigned. 

University  of  Maryland. — Dr.  Joseph  Roby  has  been  appointed  Prof,  of 
Anatomy. 

Willoughhy  Medical  School.— Dr.  Kirtland  has  accepted  the  Prof,  of  Theory 
and  Practice  of  Medicine  in  this  school. 

Pennsylvania  Hospital. — Dr.  William  Pepper  has  been  elected  one  of  the  phy- 
sicians to  this  hospital,  in  the  place  of  Dr.  Benjamin  Coates  resigned.  Dr. 
Pepper  is  a  well  educated  physician,  very  zealous  in  the  pursuit  of  pathological 
investigations.  This  appointment  will  maintain  the  attractions  of  the  hospital 
to  students  as  a  clinical  school. 

Yellow  Fever  at  Key  West. — In  our  number  for  October,  1841,  we  inserted 
an  article  on  this  subject,  sent  to  us  by  Dr.  C.  C.  Dupre.  We  have  since  re- 
ceived a  statement  impugning  the  accuracy  of  the  observations  in  that  paper,  and 
even  denying  that  Dr.  Dupre  was  on  the  Island  during  the  period  of  the  occur- 
rence of  the  yellow  fever.  Dr.  Dupre  is  unknown  to  us,  but  his  paper  being  well 
drawn  up,  and  exhibiting  every  appearance  of  authenticity,  we  did  not  hesitate 
to  give  it  an  insertion,  it  being  of  course  impossible  for  an  editor  to  vouch  for 
the  truth  of  the  statements  made  by  his  correspondents.  We  trust,  however, 
that  Dr.  D.  will  be  able  to  vindicate  his  character  in  this  case;  if  he  does  not, 
we  shall  consider  ourselves  called  on  to  publish  in  our  next  number,  the  docu- 
ment in  our  possession,  which  comes  from  a  source,  we  are  assured  by  one  of 
our  most  respected  collaborators,  entitled  to  every  confidence. 

Obituary. — It  is  with  deep  regret  that  we  record  the  death  of  Dr.  Daniel 
Oliver,  Prof,  of  Materia  Medica  in  the  Medical  College  of  Ohio,  which  took 
place  at  Cambridge,  Mass.  the  first  of  June.  Dr.  Oliver  was  formerly  Prof,  of 
Theory  and  Practice  of  Medicine  in  Dartmouth  College,  N.  H.,  and  was  the 
author  of  an  admirable  elementary  work  on  Physiology. 


UNIVERSITY  OF  PENNSYLVANIA. 

MEDICAL  DEPARTMENT.— SESSION  1842-43. 

The  Lectures  will  commence  on  Tuesday,  the  first  of  November,  and  be  con- 
tinued, under  the  following-  arrangement,  to  the  middle  of  March  ensuing: — 
Practice  and  Theory  of  Medicine,     -        -        by  Nathaniel  (Jhapman,  M.  D. 
Chemistry,       ------  *'    Robert  Hare,  M.D. 

Surgery,  ------         «'  William  Gibson,  M.D. 

Anatomy, *'   William  E.  Horner,  M.  D. 

Institutes  of  Medicine,     -        -        -        -         "  Samuel  Jackson,  M.  D. 
Materia  Medica  and  Pharmacy,         -        -         "   George  B.  Wood,  M.D. 
Obstetrics  and  the  Diseases  of  Women  and 

Children, "  Hugh  L.  Hodge,  M.  D. 

A  course  of  Clinical  Lectures  and  Demonstrations,  in  connection  with  the  above,  is 
given  at  the  very  extensive  and  convenient  Infirmary  called  the  Philadelphia  Hospital. 

Clinical  Medicine, by  W.  W.  Gerhard,  M.  D. 

Clinical  Surgery,      .-----"  Drs.  Gibson  and  Horner. 

Dr.  Horner  continues  in  public  attendance  at  the  said  Hospital  until  August  1st;  and 
as  the  tickets  of  admission  are  issued  for  one  year  from  November  1st,  they  remain 
valid  for  his  course,  and  the  other  service  of  the  house,  until  the  time  expires. 

Clinical  rnstruction  in  Medicine  is  also  given  from  the  1st  day  of  November  to  the 
1st  day  of  March  by  Dr.  Wood,  in  the  Pennsylvania  Hospital,  an  institution  which  is 
well  known  as  one  of  the  finest  and  best  conducted  Infirmaries  in  the  United  States. 

The  rooms  for  Practical  Anatomy  will  be  opened  October  1st,  and  continued  so  to 
the  end  of  March.  They  are  under  the  charge  of  Paul  Beck  Goddard,  M.D.,  Demon- 
strator, with  a  supervision  on  the  part  of  Dr.  Horner. 

Copious  additions  to  the  very  extensive  cabinets  of  Anatomy,  Materia  Medica,  Chem- 
istry, Surgery,  and  Obstetrics,  have  recently  been  made,  and  are  in  progress;  the  polity 
of  the  school  being  to  give  to  its  instructions,  both  Didactic  and  Clinical,  a  character  as 
practical  and  influential  as  possible  in  imparling  a  sound  Medical  education. 

The  Professor  of  Materia  Medica,  besides  his  Cabinet,  has  an  extensive  and  well 
furnished  Conservatory,  from  which  are  exhibited,  in  the  fresh  and  growing  state,  the 
native  and  exotic  Medicinal  Plants. 

W.  E.  HORNER,  M.  D., 
Dean  of  the  Medical  Faculty^  263  Chestnut  Street,  Philadelphia. 

Note. — A  considerable  number  of  the  distinguished  graduates  of  the  school  who  are 
in  connection  with  the  Medical  Department  of  the  Guardians  of  the  Poor,  and  with  the 
different  Dispensaries  and  Beneficiary  establishments  of  the  city,  give  Clinical  and 
Elementary  Instruction  through  the  year,  in  private,  and  in  their  rounds  of  practice,  to 
such  gentlemen  as  desire  it. 

July,  1842. 


MEDICAL  COLLEGE  OF  THE  STATE  OF  SOUTH  CAROLINA. 

The  regular  course  of  Lectures  in  this  Institution  will  be  resumed  on  the 
second  Monday  in  November. 

Anatomy, -        -        by  J.  E.  Holbrook,  M.  D. 

Surgery,      -        - "  E.  Geddings,  M.  D. 

Institutes  and  Practice  of  Medicine,      -        -         "  S.  Henrv  Dickson,  M.  D. 

Physiology, "  James  Moultrie,  M.  D. 

Materia  Medica "  Henry  R.  Frost,  M.  D. 

Obstetrics, "  Thomas  G.  Prtdleau,  M.D. 

Chemistry, "  C.  U.  Shepard,  M.  D. 

The  school  for  Practical  Anatomy  has  been  reorganized,  and  will  be  under 
the  charge  of  Prof.  Holbrook,  assisted  by  Drs.  Desaussure,  Chazal,  Sinkler, 
Gaillard,  and  Ravenel. 

Clinical  Instruction  at  College  Hospital,  Marine  Hospital  and  Almshouse. 

HENRY  R.  FROST,  Dean, 
1 


MEDICAL  INSTITUTE  OF  PHILADELPHIA, 

LOCUST  STREET,  ABOVE  ELEVENTH. 

The  course  of  Lectures  will  commence  on  Monday,  April  4th,  and  continae  until 
the  last  of  October  ensuing,  with  the  exception  of  August,  which  is  a  vacation. 

LECTURES. 

On  Practice  of  Medicine  by  \  ^  ^t'^n^Z'  ^*  ?V  t^ 

•'  ^  W.  W.  Gerhard,  M.  D. 

A  n.t«r««  3  W.  E.  Horner,  M.  D. 

^""*°™y'  )PaulB.Godd;rd,M.D. 
Institutes  of  Medicine,  Samuel  Jackson,  M.  D. 

Materia  Medica  and  Therapeutics,  John  Bell,  M.  D. 

Obstetrics,  and  Diseases  of  Women     j  Hugh  L.  Hodge,  M.  D. 
and  Children,  f  William  Harris,  M.  D. 

Principle,  and  Practice  of  Surgery,      j  ^XSoohl";  M.D. 

W.  E.  HORNER, 

Secretary. 


JEFFERSON  MEDICAL  COLLEGE  OF  PHILADELPHIA. 

Session  OF  1842-43.. 

The  regular  Lectures  will  commence  on  the  first  Monday  of  November. 
RoBLEY  DuNGLisoN,  M.  D,,  Frofessor  of  Institutes  of  Medicine  and  Medical 

Jurisprudence . 
Robert  M.  Huston,  M.  D.,  Prof  essor  of  Materia  Medica  and  General  Thera- 
peutics. 
Joseph  Pancoast,  M.  D.,  Professor  of  General,  Descriptive  and  Surgical 

Jlnatomy. 
J.  K.  Mitchell,  M.  D.,  Professor  of  Practice  of  Medicine. 
Thomas  D.  Mutter,  M.  D.,  Professor  of  Institutes  and  Practice  of  Surgery. 
Charles  D.  Meigs,  M.  D.,  Professor  of  Obstetrics  and  Diseases  of  Women 

and  Children. 
Franklin  Bache,  M.  D.,  Professor  of  Chemistry. 
Lectures  and  practical  illustrations  will  be  given  at  the  Philadelphia  Hospital 
regularly  through  the  course,  by 

Dr.  Dunglison  on  Clinical  Medicine, 
Dr.  Pancoast  on  Clinical  Surgery. 

On  and  after  the  first  of  October,  the  dissecting-room  will  be  open,  and  the 
Professor  of  Anatomy  and  the  Demonstrator,  Dr.  Jonathan  M.  Allen,  will  give 
their  personal  attendance  thereto.  Clinical  instruction  will  likewise  be  given 
regularly  at  the  Dispensary  of  the  College.  During  the  course,  ample  opportu- 
nities will  be  aiforded  to  students  of  the  school  for  Clinical  Instruction;  Profes- 
sors Dunglison,  Huston,  and  Pancoast  being  medical  officers  of  the  Philadelphia 
Hospital;  Professor  Meigs  of  the  Pennsylvania  Hospital;  and  Professor  Mutter, 
Surgeon  of  the  Philadelphia  Dispensary. 

ROBERT  M.  HUSTON,  M.  D.,  Dean  of  the  Faculty. 
*^*  Boarding  and  other  personal  expenses  of  Students  are  at  least  as  cheap 
in  Philadelphia,  as  in  any  other  city  of  the  Union. 


COLLABORATORS. 


Elisha  Bartlett,  M.  D.  Professor  of 
the  Institutes  and  Practice  of  Medicine 
in  Transylvania  University . 

T.  RoMEYN  Beck,  M.  D.  Professor  of 
Materia  Medica  in  the  Albany  Medi- 
cal College. 

John  B.  Beck,  M.D.,  Prof,  of  Mat. 
Med.  in  the  Coll.  of  Phys.  ^  Surg. 
JV.  York. 

Jacob  Bigelow,  M.  D.  Professor  of  Ma- 
teria Medica  in  Harvard  University, 
Boston. 

A.  Brigham,  M.  D.  Superintendent  and 
Physician  to  the  Connecticut  Retreat 
for  the  Insane. 

N.  Chapman,  M.  D.  Professor  of  the 
Institutes  and  Practice  of  Physic  and 
Clinical  Practice  in  the  University  of 
Pennsylvania. 

Samuel  Chew,  M.  D.  Professor  of 
Materia  Medica  in  the  University  of 
Maryland. 

B.  H.  CoATES,  M.  D.  of  Philadelphia. 
D.Francis  Condie,  M.  D,  of  Philadel- 
phia. 

S.  Henry  Dickson,  M.  D.  Professor  of 
the  Institutes  and  Practice  of  Medicine 
in  the  Medical  College  of  the  State  of 
South  Carolina. 

Gouverneur  Emerson,  M.  D.  of  Phi- 
ladelphia. 

Charles  Evans,  M.  D.  Atteiiding  Phy- 
sician to  the  Friends''  Asylum,  Frank- 
ford. 

Paul  F.  Eve,  M.  D.  Professor  of  Sur- 
gery in  the  Medical  College  of  Geor- 
gia. 

John  D.  Fisher,  M.  D.  of  Boston. 

Samuel  Forry,  M.  D.  of  New  York. 

E.  Geddings,  M.  D.  Professor  of  Sur- 
gery in  the  Medical  College  of  the  State 
of  South  Carolina. 

William  Gibson,  M.  D.  Professor  of 
Surgery  in  the  University  of  Pennsyl- 
vania. 

R.  E.  Griffith,  M.  D.  late  Professor  of 
Medicine  in  the  University  of  Virgi- 
nia. 

Thomas  Harris,  M.  D.  Surgeon  U.  S. 
Navy. 

E.  Hale,  M.  D.  Physician  to  the  Mas- 
sachusetts General  Hospital. 


Hugh  L.  Hodge,  M.  D.  Prof,  of  Mid- 
wifery in  the  University  of  Penn. 

George  Hay  ward,  M.  D.  Professor  of 
the  Principles  of  Surgery  and  Clinical 
Surgery  in  Harvard  University,  Bos- 
ton. 

Charles  R.  King,  M.  D.  of  New  York. 

T.  S,  KiRKBRiDE,  M.  D.  Physician  to  the 
Pennsylvania  Hospital  for  the  Insane, 

Samuel  Jackson,  M.  D.Professorofthe 
Institutes  of  Medicine  in  the  University 
of  Pennsylvania. 

Samuel  Jackson,  M.  D.  Philadelphia. 

William  E.  Horner,  M.  D.  Professor 
of  Anatomy  in  the  University  of  Penn- 
sylvania. 

C.  A.  Lee,  M.  D.  of  New  York. 

Valentine  Mott,  M.  D.  Professor  of 
Surgery  in  the  University  of  New  York. 

James  McNaughton,  M.  D.  Professor 
of  the  Theory  and  Practice  of  Medicine 
in  Albany  Medical  College. 

Reuben  D.  Mussey,  M.  D.  Professor  of 
Surgery  in  the  Medical  College  of  Ohio. 

T.  D. "Mutter,  M.  D.  Professor  of  Sur- 
gery in  Jefferson  Medical  College. 

G.  W.  NoRRis,  M.  D.  one  of  the  Sur- 
geons to  the  Pennsylvania  Hospital. 

0.  W.  Pennock,  M.D.  one  of  the  Phy- 
sicians to  the  Philadelphia  Hospital, 
Blockley. 

Thomas  Sewall,  M.  D.  Professor  of 
Anatomy  and  Physiology  in  the  Co- 
lumbian College,  District  of  Columbia. 

Nathan  R.  Smith,  M.  D.  of  Baltimore. 

Thomas  Stewardson,  M.  D.  one  of  the 
Physicians  to  the  Pennsylvania  Hos- 
pital. 

Alfred  Stille,  M.  D.  of  Philadelphia. 

John  A.  Swett,  M.  D.  of  New  York. 

A.  F.  Vache,  M.  D.  of  New  York. 

John  Ware,  M.  D.  Professor  of  the 
Theory  and  Practice  of  Physic  in 
Harvard  University,  Boston. 

John  C.  Warren,  M.  D.  Professor  of 
Anatomy  and  Surgery  in  Harvard 
University,  Boston. 

Edward  Warren,  M.  D,  of  Boston. 

John  Watson,  M.  D.  one  of  the  Sur- 
geons of  the  New  York  Hospital. 

G,  B.  Wood,  M.  D.  Professor  of  Ma- 
teria Medica  and  Pharmacy  in  the  Uni- 
versity of  Pennsylvania. 


EDITOR— Isaac  Hays,  M.  D.,  one  of  the  Surgeons  to  Wills  Hospital  for  the 
Blind  and  Lame,  ^c. 
No.  VIII.— OcTOCER,  1842.  23 


PUBLISHERS'  NOTICE. 


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bers who  have  not  remitted  the  amount  of  their  dues 
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payment  by  distant  subscribers,  and  the  publishers 
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same  time  solicit  the  medical  profession  generally 
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of  this  long  established  Journal.  Devoted,  as  it  has 
always  been,  to  the  best  interests  of  the  profession, 
an  effort  on  the  part  of  its  members,  would  assist  the 
proprietors  in  the  improvement  of  the  work,  and  en- 
able them  to  extend  its  sphere  of  usefulness.  The 
beginning  of  the  new  year  will,  it  is  hoped,  see  this 
improvement,  and  no  effort  shall  be  wanting  on  their 
part  to  maintain  the  character  which  the  Journal  has 
sustained  through  a  long  series  of  years,  at  home  as 
well  as  abroad.  Remittances  and  orders  can  be  made 
through  the  Postmasters  free  of  expense. 

Philadelphia,  October,  1842. 


TO  READERS  AND  CORRESPONDENTS. 


The  following-  works  have  been  received: — 

The  History,  Pathology,  and  Treatment  of  Puerperal  Fever  and  Crural  Phle- 
bitis. 1.  A  Treatise  on  the  Epidemic  Puerperal  Fever  of  Aberdeen.  By  Alex. 
Gordon,  M.  D.  2.-  A  Treatise  on  the  Puerperal  Fever:  illustrated  by  cases 
which  occurred  in  Leeds  and  its  vicinity  in  the  years  1809-12.  By  Wm.  Hev, 
Esq.  3.  Facts  and  Observations  relative  to  the  fever  commonly  called  Puerpe- 
ral. By  John  Armstrong,  M.  D.  4.  On  Puerperal  Fever  and  Crural  Phle- 
bitis. By  Robert  Lee,  M.  D.  With  an  Introductory  Essay,  by  Charles  D. 
Meigs,  M.  D.,  Prof,  of  Obstetrics  and  Diseases  of  Women  and  Children  in  Jef- 
ferson Med.  College.     Philadelphia,  1842.     (From  Dr.  Meigs.) 

Medical  Communications  of  the  Massachusetts  Medical  Society,  vol.  vii,  pt. 
1.     Boston,  1842.     (From  Dr.  S.  W.  Williams.) 

Third  Annual  Report  of  the  Registrar-General  of  Births,  Deaths,  and  Mar- 
riages in  England.     London,  1841.     (From  the  Registrar-General.) 

Proceedings  of  the  Medical  Society  of  the  State  of  Tennessee,  at  their  thir- 
teenth Annual  Meeting,  held  in  the  city  hall,  Nashville,  May,  1842.  Nash- 
ville, 1842.     (From  the  Society.) 

Catalogue  of  the  Trustees,  Faculty  and  Students  of  the  Medical  College  of 
the  State  of  South  Carolina,  1842.     (From  the  Faculty.) 

Quarterly  Summary  of  the  Transactions  of  the  College  of  Physicians  of  Phila- 
delphia.    May,  June  and  July,  1842.     (From  the  College.) 

A  Treatise  on  Strabismus,  with  a  description  of  new  Instruments  designed  to 
improve  the  operation  for  its  cure,  in  simplicity,  ease  and  safety.  Illustrated 
by  cases.  By  James  Bolton,  M.  D.,  A.M.,  &c.  Richmond,  1842.  (From 
the  Author.) 

An  Exposition  of  the  Pathology  of  Hysteria,  elucidated  by  a  reference  to  the 
Origin,  Diagnosis,  Symptomatology,  Pathology  and  Treatment  of  Hysterical 
Amaurosis.  By  Edward  Octavius  Hocken,  M.  D.,  &c.  London,  1842.  (From 
the  Author.) 

A  Treatise  on  the  Diseases  of  the  Heart  and  Great  Vessels,  and  on  the  affec- 
tions which  may  be  mistaken  for  them,  &c.  By  J.  Hope,  M.  D.,  F.  R.  S.,  &c. 
First  American  from  the  third  London  edition.  With  Notes,  and  a  detail  of 
recent  Experiments.  By  C.  W.  Pennock,  M.  D.,  Attending  Physician  to  the 
Philadelphia  Hospital.  Philadelphia:  Haswell  &  Johnson,  1842.  (From  the 
Publishers.) 

Proceedings  of  the  President  and  Fellows  of  the  Connecticut  Medical  Soci- 
ety, in  convention.  May,  1842.     Hartford,  1842.     (From  Dr.  A.  Welsh.) 

Catalogue  of  the  Students  and  Graduates  of  the  Spring  term,  1842,  and  An- 
nual Announcement  of  the  Fall  Session,  1842.     (From  Dr.  McClintock.) 

Annual  Circular  of  the  Medical  Department  of  Kemper  College;  together 
with  an  Address  delivered  before  the  Alumni  of  the  College  at  the  commence- 
ment, March  1,  1842,  by  John  S.  Moore,  M.  D.,  Prof.  Theory  and  Practice  of 
Medicine.     St.  Louis,  1842.     (From  Prof.  Moses.) 


268  TO  READERS  AND  CORRESPONDENTS. 

Annual  Announcement  of  the  Medical  College  of  Georgia.  (From  the 
Faculty.) 

An  Address  to  the  Graduating  Class  of  the  Medical  College  of  Georgia.  By 
Charles  J.  Jenkins,  on  the  4th  of  March,  1842.     (From  the  Medical  Faculty.) 

Charter,  Constitution,  and  By-laws  of  the  Medical  Society  of  Missouri.  St. 
Louis,  1842.     (From  the  Society.) 

Elements  of  Surgery.  By  Robert  Liston,  Surgeon  to  the  North-London 
Hospital,  Professor  of  Clinical  Surgery,  &c.  &c.  From  the  second  London 
edition,  with  copious  Notes  and  Additions.  By  Samuel  D.  Gross,  M.  D.,  Prof. 
Surgery  in  the  Louisville  Medical  Institute,  &c.  &c.  Illustrated  with  nume- 
rous engravings.  Philadelphia:  Edw.  Barrington  &  Geo.  D.  Haswell,  1842. 
(From  the  Publishers.) 

The  Eighteenth  Annual  Report  of  the  Officers  of  the  Retreat  for  the  Insane, 
at  Hartford:     Hartford,  1842.     (From  Dr.  Brigham.) 

The  Principles  and  Practice  of  Modern  Surgery.  By  Robert  Druitt.  From 
the  second  London  edition,  illustrated  with  fifty  wood  engravings.  With  Notes 
and  Comments,  by  Joshua  B.  Flint,  M.  D.,  M.  M.  S.  S.,  Lecturer  on  Thera- 
peutic and  Operative  Surgery  in  the  Louisville  Acad,  of  Med.,  &c.  &c.  Phila- 
delphia: Lea  &  Blanchard,  1842.     (From  the  Publishers.) 

Exposition  of  the  Conduct  and  Character  of  Dr.  John  Augustine  Smith,  Pre- 
sident of  the  College  of  Physicians  and  Surgeons  in  the  city  of  New  York,  and 
Professor  of  Physiology;  as  exhibited  in  the  session  of  1839-40.  By  James  R. 
Manley,  M.  D.,  Late  Lecturer  on  Obstetrics.  New  York,  1842.  (From  the 
Author.) 

Fourth  Book  of  Natural  History.  Prepared  for  the  use  of  Schools  and  Col- 
leges. By  W.  S.  W.  Ruschenberger,  M.  D.,  Surgeon  U.  S.  Navy,  &c.  &c. 
Turner  &  Fisher,  1842. 

Introductory  Lecture  before  the  Medical  Class  in  Castleton  Medical  College, 
at  the  opening  of  the  Fall  session,  1842.  By  D.  M.  Reese,  A.  M.,  M.  D.,  Prof. 
Theory  and  Practice  of  Physic.     Castleton,  Vt.,  1842.     (From  the  Author.) 

Die  Medicinal-Ordnung  ine  Grosherzogthum  Mecklenburgh-Schwerin  cri- 
lisch  erortest  von  A.  L.  Dornbluth,  M.  D.,  &c.  Gustrow,  1840.  (From  Dr. 
Oppenheim.) 

Medicinische  Statistik  der  innerlichen  Abtheilung  des  Catharinen-Hospitales 
zu  Stuttgart  in  seinem  ersten  Decennium  1828-1838.  Von  Dr.  Georg  Cless. 
Stuttgart,  1841.     (From  Dr.  Oppenheim.) 

Provincial  Medical  Journal  and  Retrospect  of  the  Medical  Sciences.  June, 
July,  and  August,  1842.     (In  exchange.) 

The  London  Medical  Gazette.     May,  June  and  July,  1842.     (In  exchange.) 

The  Dublin  Medical  Press.     June,  July  and  August,  1842.     (In  exchange.) 

The  London  and  Edinburgh  Monthly  Journal  of  Medical  Science.  Edited  by 
John  Rose  Cormack,  M.  D.     June,  July,  August,  1842.     (In  exchange.) 

The  Edinburgh  Medical  and  Surgical  Journal.     July,  1842.     (In  exchange.) 

The  Medico-Chirurgical  Review  and  Journal  of  Practical  Medicine.  July, 
1842.     (In  exchange.) 

The  British  and  Foreign  Medical  Review,  or  Quarterly  Journal  of  Practical 
Medicine  and  Surgery.     July,  1842.     (In  exchange.) 


TO  READERS  AND  CORRESPONDENTS.  269 

The  Retrospect  of  Practical  Medicine  and  Surgery,  being  a  half  yearly  Jour- 
nal, containing  a  retrospective  view  of  every  discovery  and  practical  improve- 
ment in  the  Medical  Sciences.  Edited  by  W.  Braithwaite,  Surgeon  to  the 
Leeds  General  Eye  and  Ear  Infirmary.     Jan.,  July,  1842.     (In  exchange.) 

Revue  Medicale.  Jan.  Feb.  March,  Ap.  May  and  June,  1842.  (In  ex- 
change.) 

Journal  de  Medecine  et  de  Chirurgie  Pratiques.  Feb.  March,  Ap.  May,  June 
and  July,  1842.     (In  exchange.) 

Journal  des  Connaissances  Medico-Chirurgicales,  Feb,  March,  Ap.  May, 
June,  1842.     (In  exchange.) 

Gazette  Medicale  de  Paris.  Jan.  Feb.  March,  April,  May,  and  June,  1842. 
(In  exchange.) 

Journal  des  Connaissances  Medicales  Pratiques  et  de  Pharmacologic,  Jan. 
Feb.  March,  April,  June,  1842.     (In  exchange.) 

Journal  de  Pharmacie  et  de  Chimie.  Feb.  March,  April,  May,  and  June,  1842. 
(In  exchange.) 

L'Examinateur  Medicale.  Jan.  Feb.  March,  April,  May,  June,  1842.  (In 
exchange.) 

Zeitschrift  fiir  die  gesammte  Medicin,  mit  besonderer  Riicksicht  auf  Hospital- 
praxis  und  auslandische  Literatur.  Herausgegeben  F.  W.  Oppenheim.  Sep. 
Oct.  Nov.  Dec.  1841,  Jan.  Feb.  March,  1842.     (In  exchange.) 

Jahrbuch  der  gesammten  Staatsarzneikunde.  Herausgegeben  von  Dr.  C.  F. 
L.  WiLDBERG.    Vol.  vi,  No.  3,  vol.  vii,  No.  1  and  2.    (From  Dr.  Oppenheim.) 

Archief  voor  genecskunde.  Door  Dr.  J.  P.  Heije,  1841.  (From  Dr.  Oppen- 
heim.) 

Wenken  en  Meeningen  omtrent  geneeskundige  Staatsregeling  en  Algemeene 
geneskunde.     Door  J.  P.  Heije.     1841.     (From  Dr.  Oppenheim.) 

Boston  Medical  and  Surgical  Journal.  July,  Aug.  and  Sept.  1842.  (In 
exchange.) 

The  Medical  Examiner,  July,  Aug.  and  Sept.  1842.     (In  exchange.) 

The  New  York  Medical  Gazette,  July,  1842.     (In  exchange.) 

The  Guardian  of  Health.     July,  1842.     (In  exchange.) 

The  American  Journal  of  Science  and  the  Arts.     July,  1842.    (In  exchange.) 

The  American  Medical  Library  and  Intelligencer.     June,  1842. 
(In  exchange.) 

The  Select  Medical  Library  and  Bulletin  of  Medical  Science.  July,  1842. 
(In  exchange.) 

The  New  York  Lancet.     July,  Aug.  and  Sept.  1842.     (In  exchange.) 

The  Western  Lancet.     July  and  August,  1842.     (In  exchange.) 

The  American  Journal  of  Pharmacy.     July,  1842.     (In  exchange.) 

The  Maryland  Medical  and  Surgical  Journal.  April  and  Sept.  1842.  (In 
exchange.) 

The  Western  Journal  of  Medicine  and  Surgery.  July,  Aug.  1842.  (In  ex- 
change.) 

Q;y^  The  advertisement  sheet  belongs  to  the  business  department  of  the 
Journal,  and  all   communications   for  it  should   be  made  to   the  publishers 

23* 


270  TO  READERS  AND  CORRESPONDENTS. 

under  whose  exclusive  control  it  is.  The  editor  does  not  even  revise  the  proof 
sheets. 

Communications  intended  for  publication,  and  Books  for  Review,  should  be 
sent,/ree  of  expense,  directed  to  Isaac  Hays,  M.  D,,  Editor  of  the  Amer.  Journ. 
of  Med.  Sci.,  care  of  Messrs.  Lea  &  Blanchard,  Philadelphia.  Parcels  directed 
as  above,  and  sent  (carriage  paid)  under  cover,  to  John  Miller,  Henrietta  Street, 
Covent  Garden,  London,  or  to  Wiley  &  Putnam,  New  York,  or  W.  D.  Ticknor, 
Boston,  will  reach  us  safely.  We  particularly  request  the  attention  of  our 
foreign  correspondents  to  the  above,  as  we  are  often  subjected  to  unnecessary 
expense  for  postage  and  carriage. 

All  remittances  of  money  and  letters  on  the  business  of  the  Journal,  should  be 
addressed  exclusively  to  the  publishers,  Messrs.  Lea  &  Blanchard.  .^ 


m: 


CONTENTS 

OF   THE 

AMERICAN    JOURNAL 

I  OF  THE 

MEDICAL    SCIENCES. 

No.  VIII,  NEW  SERIES. 

OCTOBER,  1842. 

ORIGINAL  COMMUNICATIONS. 

MEMOIRS  AND  CASES. 

ART.  PAGE. 

I.  Osteo-Sarcoma  of  Lower  Jaw — Amputation — Cure.  By  Charles  Bell 
Gibson,  M.  D.,  of  Baltimore. 277 

II.  On  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis.  By  Chas.  0.  Hil- 
dreth,  M.  D.,  of  Zanesville,  Ohio. 281 

III.  On  Typhoid  Pneumonia,  as  it  occurs  in  the  neighbourhood  of  Co- 
lumbia, S.  C.     By  R.  W.  Gibbes,  M.  D.,  of  Columbia,  S.  C.        -        -  289 

IV.  On  the  use  of  the  unripe  fruit  of  the  Diospyros  Virginiana,  as  a  The- 
rapeutic Agent.     By  John  P.  Mettauer,  M.  D.,  of  Virginia.    -         -         -  297 

V.  On  Endemic  Sore  Mouth  and  Diarrhoea  peculiar  to  Nursing  Women. 

By  Lewis  Shanks,  M.  D.,  of  Memphis,  Tennessee.         _        _        >        _  300 

VI.  On  the  Treatment  of  Deformities,  following  unsuccessfully  treated 
Fractures.  By  George  W.  Norris,  M.  D.,  one  of  the  Surgeons  to  the 
Pennsylvania  Hospital.  -.-.-_-_.  305 

VII.  Two  cases  of  Black  Vomit,  with  Observations.  By  Richard  D.  Arnold, 

M.  D.,  of  Savannah. 316 

VIII.  Paralysis  of  the  Face,  successfully  treated  with   Strychnine.     By 

B.  F.  Joslin,  M.  D.,  of  the  city  of  New  York. 322 

IX.  Remarks  on  the  propriety  and  best  manner  of  breaking  and  extract- 
ing large  Calculi  in  the  lateral  operation.     By  Josiah  C.  Nott,  M.  D., 

of  Mobile. 328 

X.  Aneurism  of  the  Femoral  Artery,  showing  the  importance  of  applying  a 
ligature  below,  as  well  as  above  the  Sac.  By  Wm.  E.  Horner,  M.D., 
Professor  of  Anatomy  in  the  University  of  Pennsylvania,  Surgeon  at  the 
Philadelphia  Hospital,  &c. 332 

XL  Plastic  Operations.  By  J.  Pancoast,  M.D.,  Professor  of  Anatomy  in 
Jefferson  Medical  College.     -        -        -        - 337 

XII.  Treatment  of  Hemorrhoids.  By  Wm,  E.  Horner,  Professor  of  Ana- 
tomy in  the  University  of  Pennsylvania. 358 

XIII.  Suggestion  as  to  the  Cause  of  the  Crepitant  Rhonchus.  By  Edson 
Carr,  M.  D.,  of  Canandaigua,  N.  Y. 360 

XIV.  On  Creasote  in  diseases  of  the  Conjunctiva  and  Cornea.     By  Chas. 

C.  Hildreth,  M.  D.,  of  Zanesville,  Ohio. 362 

XV.  Chronic  Enlargement  of  the  Spleen.  By  N.  S.  Davis,  M.  D.,  of 
Binghamton,  N.  Y.       -        - -  367 

XVI.  Case  of  Gelatinous  Polypus,  cured  with  Sanguinaria  Canadensis 
after  extraction  had  twice  failed.  By  Lewis  Shanks,  M.  D.,  of  Mem- 
phis, Tennessee. 368 


272  CONTENTS. 

ART.  PAGE. 

XVH.  Case  of  Spontaneous  Rupture  of  the  Spleen.  By  John  Neill, 
M.  D.  -        - 369 

XVIII.  Operation  for  Artificial  Pupil.  By  Isaac  Hays,  M.  D.,  Surgeon  to 
Wills  Hospital. 371 

XIX.  Improvement  on  the  Tourniquet,  by  Silon  A.  Henkel,  M.  D.,  of 
New  Market,  Va.  -        -        - 373 

REVIEWS. 

XX.  Du  Traitement  Moral  de  la  Folie.  Par  F.  Leuret,  Medecin  de  I'Hos- 
pice  de  Bicetre.     Paris,  1840:  pp.  4fi2. 

On  the  Moral  Treatment  of  Insanity.  By  F.  Leuret,  Physician  to  the  Bi-' 
cetre  Asylum.     Paris:  1840. 375 

XXI.  Medicinische  Statistik  der  innerlichen  Abtheilung  des  Catharinen- 
Hospitales  zu  Stuttgart,  in  seinem  ersten  Decennium,  1828 — 1838.  Von 
Dr.  Georg-  Cless.  Mit  einer  Lithographie  und  sieben  Tabellen.  Stutt- 
gart; Verlag  von  Ebner  &  Seubert,  1841. 

Medical  Statistics  of  the  Interior  Division  of  the  Catharine-Hospital  at 
Stuttgart,  during  its  first  decennium,  1828—1838.  By  Dr.  George  Cless. 
With  one  lithograph  and  seven  tables.  Stultgart:  Ebner  &  Seubert, 
1841,  quarto,  pp.  96. 388 

BIBLIOGRAPHICAL  NOTICES. 

XXII.  The  History,  Pathology,  and  Treatment  of  Puerperal  Fever  and 
Crural  Phlebitis.  I.  A  Treatise  on  the  Epidemic  Puerperal  Fever  of  Aber- 
deen. By  Alexander  Gordon,  M.  D.  II.  A  Treatise  on  the  Puerperal 
Fever,  illustrated  by  cases  which  occurred  in  Leeds  and  its  vicinity,  in 
the  years  1809-12.  By  William  Hey,  Esq.  III.  Facts  and  Observations 
relative  to  the  Fever,  commonly  called  Puerperal.  By  John  Armstrong, 
M.  D.  IV.  On  Puerperal  Fever  and  Crural  Phlebitis.  By  Robert  Lee, 
M.D.,  F.  R.  S.     With  an  Introductory  Essay.     By  Charles  D.  Meigs, 

M.  D.,  Slc.  Philadelphia:  1842.   Barrington  and  Haswell,  8vo.  pp.  338.     399 

XXIII.  Specimen  Medicum  Inaugurale,  de  Morbosa  Gazorum  Secretione. 
Auctore  J.  L.  Siemens.     Groningen,  1841:  8vo.  pp.  64. 

On  the  Morbid  Secretion  of  Gases.     By  J.  L.  Siemens.  _         .        _  402 

XXIV.  Om  de  Sanitaire  Forholde  i  Faengsler  efter  nyere  Systemer,  Ved 
Professor  Frederik  Hoist,  M.  D. 

The  Influence  of  the  New  Penitentiary  System  upon  the  Health  of  the 
Prisoners.  By  Professor  F.  Hoist,  M.  D.  8vo.  pp.  30:  Christiania,  1840.  405 

XXV.  The  Eighteenth  Annual  Report  of  the  Officers  of  the  Retreat  for 

the  Insane  at  Hartford.     Hartford,  1842,  pp.  36. 407 

XXVI.  Quarterly  Summary  of  the  Transactions  of  the  College  of  Physi- 
cians of  Philadelphia,  May,  June,  and  July,  1842,  pp.  24,  8vo.       -         -  410 

XXVII.  Third  Annual  Report  of  the  Registrar-General  of  Births,  Deaths, 
and  Marriages  in  England.     London,  1841:  pp.  362,  12mo.    -         -        -  418 

XXVIII.  A  Treatise  on  the  Diseases  of  the  Heart  and  Great  Vessels,  and  on 
the  affections  which  may  be  mistaken  for  them.  Comprising  the  Author's 
view  of  the  Physiology  of  the  Heart's  Action  and  Sounds,  as  demonstrated 
by  his  Experiments  on  the  Motions  and  Sounds  in  1830,  and  on  the  Sounds 
in  1834-5.  By  J.  Hope,  M.  D.,  F.  R.  S.,  of  St.  George's  Hospital;  for- 
merly Senior  Physician  to  the  Marylebone  Infirmary;  Extraordinary 
Member,  and  formerly  President,  of  the  Royal  Medical  Society  of  Edin- 
burgh, &c.  First  American  from  the  third  London  edition.  With  Notes, 
and  a  Detail  of  recent  Experiments.  By  C.  W.  Pennock,  M.  D.,  Attending 
Physician  to  the  Philadelphia  Hospital,  Blockley.  Philadelphia:  Lea  & 
Blanchard,  1842:  8vo.  pp,  572,  plates  ix,       •. 430 


CONTENTS.  273 

ART.  PAGE. 

XXIX.  Cours  de  Pathologie  et  de  Therapeutique  Generales,  fait  a  la  Faculte 
de  Medecine  de  Paris,  par  M.  Andral;  compte-rendu  par  M.  Monneret, 
agrege  pres  cette  Faculte,  Medecin  de  bureau  central.     Gazette  Medicale 

de  Paris,  10  Sept.  1841, 432 

XXX.  The  Principles  and  Practice  of  Modern  Surgery.  By  Robert  Druitt. 
"Id  potissimum  agens,  ut  omissis  hypothesibus,  in  praxi  nihil  adstruat 
quod  multiplici  experientia  non  sit  roboratum." — Act.  Erud.  Lips.  1722. 
From  the  second  London  Edition,  Illustrated  with  fifty  wood  Engrav- 
ings; with  Notes  and  Comments.  By  Joshua  B.  Flint,  M.D.— MM.  SS., 
Lecturer  on  Therapeutic  and  Operative  Surgery  in  the  Louisville  Acad- 
emy of  Medicine,  and  late  Professor  of  Surgery  in  the  Medical  Institute 

of  Louisville.     Philadelphia:  Lea  and  Blanchard,  1842;  8vo.  pp.  534.  -  439 

XXXI.  Medical  Communications  of  the  Massachusetts  Medical  Society. 
Vol.  vii,  pt.  1.     Second  Series,  vol.  iii,  pt.  1.   Boston,  1842:  pp.  76,  8vo.  440 

XXXII.  A  Series  of  Anatomical  Plates;  with  References  and  Physiological 
Comments,  illustrating  the  Structure  of  the  different  parts  of  the  Human 
Body.  Edited  by  Jones  Quain,  M.  D.,  Prof,  of  Anat.  and  Phys.  in  the  Uni- 
versity of  London,  and  W.  J.  Erasmus  Wilson,  Lecturer  on  Practical  and 
Surgical  Anatomy  and  Physiology.  By  Joseph  Pancoast,  M.  D.,  Professor 
of  Genera],  Descriptive,  and  Surgical  Anatomy  in  the  Jefferson  Medical 
College  of  Philadelphia,  Lecturer  on  Clinical  Surgery  to  the  Philadel- 
phia Hospital,  &c.  &c.  American  edition  revised,  with  additional  notes. 
Philadelphia:  Carey  &  Hart,  for  G.  N.  Loomis,  1842:  4to.  pp.  445,  and 
200  plates. -  440 

XXXIII.  A  Treatise  on  Amaurosis  and  Amaurotic  Affections.  By  Edward 
Octavius  Hocken.  Philadelphia:  Haswell  and  Johnson,  1842:  pp. 
201,  8vo. 

An  exposition  of  the  Pathology  of  Hysteria;  elucidated  by  a  reference  to  the 
Origin,  Diagnosis,  Symptomatology,  Pathology  and  Treatment  of  Hyste- 
rical Amaurosis.  By  Edward  Octavius  Hocken,  M.  D.,  M.  R.  C.  S.  L., 
&c.    London;  Samuel  Highley,  1842:  pp.  32,  12mo.      -         -         -         »  440 

XXXIV.  Elements  of  Surgery.  By  Robert  Liston,  Surgeon  to  the  North- 
London  Hospital,  Prof,  of  Clinical  Surgery,  &c.  &c.  &c.  From  the 
second  London  edition,  with  copious  Notes  and  Additions.  By  Samuel 
D.  Gross,  M.D.,  Prof,  of  Surg,  in  the  Louisville  Medical  Institute,  Sur- 
geon to  the  Louisville  Marine  Hospital,  &c.  &c.  Illustrated  with  numerous 
engravings.  Philadelphia,  Edvv.  Barrington  &  Geo.  D.  Haswell,  1842: 
pp.  640,  8vo. 441 

XXXV.  A  Treatise  on  Strabismus,  with  a  description  of  new  instruments 
designed  to  improve  the  operation  for  its  Cure  in  simplicity,  ease  and 
safety,  illustrated  by  cases.  By  James  Bolton,  M.  D.,  A.  M.,  Member  of 
the  Medical  Society  of  Virginia.  Richmond,  1842:  pp.  36,  12mo.,  plate  1.  441 

XXXVI.  A  Treatise  on  the  Diseases  of  the  Eye.  By  V^.  Lawrence,  F.  R. 
S.;  Surgeon  Extraordinary  to  the  Queen;  Surgeon  to  St.  Bartholomews, 
and  Lecturer  on  Surgery  at  that  Hospital;  late  Surgeon  to  the  London 
Ophthalmic  Infirmary,  &c.  &c.  Second  edition,  revised,  corrected  and 
enlarged.     London,  1841.  8vo.  pp.  820.  ---_.,  441 

XXXVII.  Three  Memoirs  on  the  Development  and  Structure  of  the  Teeth 
and  Epithelium,  read  at  the  ninth  annual  meeting  of  the  British  Associa- 
tion for  the  encouragement  of  Science,  held  at  Birmingham,  in  August 
1839;  with  Diagrams  exhibited  in  illustration.  By  Alexander  Nasymth, 
F.  L.  S.,  F.  G.  S.,  Member  of  the  Royal  College  of  Surgeons.  London: 
John  Churchill,  1841:  8vo.  pp.  47.        -         -         -         -°       -         -         -  442 

XXXVUI.  The  Anatomist's  Vade  Mecum;  a  System  of  Human  Anatomy. 
By  Erasmus  Wilson.  Second  edition.  London.  1842:  8vo.,  pp.  595. 
With  167  illustrations  by  Bagg. 442 


274 


CONTENTS. 


SUMMARY 


IMPROVEMENTS    AND    DISCOVERIES 
MEDICAL    SCIENCES. 


IN    THE 


FOREIGN  INTELLIGENCE. 

Anatomy  and  Physiology. 


L  Cases  proving  the  Influence  of 
the  Cerebro-Spinal  Axis  in  the 
production  of  Animal  Heat.  By 
M.  Brugnoli.     -        -        - 

Influence  of  the  Nerves  on 
Muscular  Irritability.  By  M. 
Lontret.     -        -        -        - 

Influence  of  the  Pneumogastric 
Nerve  on  the  movements  of  the 
stomach.    By  M.  Longet.  - 

4.  On  the  Blood-globules,  their 
Formation  and  their  Use.  By  M. 


2. 


3. 


-  443 


-  444 


444 


Donne.  -  .  -  -  - 
5.  On  the  Eflfects  of  an  imperme- 
able covering  applied  to  the 
Skin.  By  MM.  Becquerel  and 
Breschet.  -        -        _        - 

On  the  Coloration  of  the  Bones 
by  Madder.  By  MM.  Serres  and 
Doyere. 

Physiological  Observations  on 
Double  Uterus.  By  M.  Dumas. 

Transposition  of  the  Viscera. 
By  M.  Gerdy. 


PAGE 

■  444 


445 


445 


447 


447 


Materia  Medica  and  Pharmacy. 


9.  Emmenagogue   Solution.     By 

M.  Bouchardat.  .        -         -  447 

10.  Chalybeate  Preparations.  By 
Mr.  Wm.  Tyson.       -        -        -  448 

11.  Mode   of  preserving   Nitrate 

of  Silver.     By  M.  Dumeril.       -  449 


12.  External  application  of  Cro- 

ton  Oil. 449 

13.  On  the  use  of  the  Ergot  of 
Rye.     By  Dr.  Geo.  Fife.  -        -  449 

14.  Ergot  of  Rye.     By  Dr.  Wm. 
Catlett. 450 

15.  Ergot.     By  M.  Bonjean.       -  451 


Medical  Pathology  and  Therapeutics  and  Practical  Medicine. 


16.  Observations  on  the  Preven- 
tion and  Treatment  of  Apoplexy 
and  Hemiplegia.  By  Dr.  Mar- 
shall Hall.         -         -        -        -  452 

17.  Quantity  of  Blood  virithin  the 
Cranium.     By  Mr.  Jolly.  -  455 

18.  Blood  in  the  Brains  of  Ani- 
mals bled  to  death.  By  Mr. 
Crisp. 456 

19.  Belladonna  in  Epilepsy.  By 
Dr.  Debreyne.  -        -         -        -  456 

20.  Nature  and  Treatment  of 
Scrofula.     By  Dr.  Roesch.         -  457 

21.  State  of  the  Blood  in  Hydro- 
phobia.    By  Prof.  Berres.  -  457 

22.  Disease  of  the  Kidney.  By 
Dr.  Barlow.       -        -        -        -  457 

23.  Simple  and  Double  Pneumo- 


thorax.     By  Dr.  Puchelt,  Jr. 

24.  Influence  of  Light  on  the  de^ 
velopment  of  the  Small-pox  Pus 
tule.     By  M.  Serres. 

25.  Urea  secreted  in  large  quan- 
tity by  the  peritoneum  in  a  case 
of  Ascites.     By  Prof.  Kane. 

26.  Nature  and  Treatment  of  Stri- 
dulous  Convulsion  in  Infants. 
By  Marshall  Hall,  M.  D.  - 

27.  Two  fatal  cases  of  Laryngis- 
mus Stridulus.  By  Mr.  F.  Ry- 
land.         .        .        .        -        - 

28.  Statistics  of  Phthisis.  By  Dr. 
Hughes.   -        -        -        • 

29.  Statistical  Researches  into  the 
Etiology  of  Pulmonary  Phthisis. 
By  M.  Briquet. 


458 


-  459 


459 


459 


462 


-  464 


465 


CONTENTS. 


275 


Surgical  Pathologv  and  Therapeutics  and  Operative  Surgery. 


PAGE 

30.  Ecchymosis  from  injury  sim- 
ulating-  laceration   of  an   artery 

of  the  part.     By  Dr.  Houston.      465 

31.  Rupture  of  the  Urethra,  with 
extravasation  of  urine  into  the 
scrotum  and  penis.  By  Dr. 
Bellingham.      -        -        -        -467 

33.  Spontaneous  Fracture  of  the 
Thigh-bone.  By  Mr.  Toogood, 
and  Mr.  Salter.  -        -        -  469 

33.  Fracture  of  the  Thigh  by  mus- 
cular contraction.  By  M.  Nara- 
novitch.     -----  470 

34.  Dislocation  of  the  Lower 
Jaw.     By  Mr.  D.  Donovan.   -      470 

35.  Benzoic  Acid  in  Urinary  Dis- 
orders. By  Dr.  J.  K.  Walker, 
and  Mr.  J.  S.  Soden.  -         -  470 

36.  Post-mortem  Examination  of 
the  Duke  of  Orleans.         -        -  472 

37.  Caries  of  the  tenth  and 
eleventh  Ribs — Excision — Cure. 

By  M.  Jaequet.  -         -         -  473 

38.  Superficial  Cancers.  By  M. 
Lisfranc. 474 

39.  Ununited  Fracture  of  the  Hu- 
merus cured  by  the  insertion  of  a 


Seton  at  two  different  periods. 
By  MM.  Mawroury  and  Thore. 

40.  Tumours  in  the  Bladder.  By 
Mr.  Douglas.    -         -        -        - 

41.  Scriveners'  Spasm  cured  by 
division  of  muscles.  By  Prof. 
Stromeyer.        -        -        -        - 

42.  Tumours  developed  on  Cica- 
trices.    By  M.  Gimelle.    • 

43.  Fracture  of  Cranium  with 
considerable  loss  of  the  sub- 
stance of  the  Brain.  By  Dr. 
Zartmann. 

44.  Ligature  of  the  Subclavian 
and  Arteria  Innominata  arteries 
for  wound  in  the  Arm-pit.  By 
M.  Hutin.  -        -        - 

45.  Nature  and  Treatment  of 
common  Toothache.  By  Mr. 
T.  Wilkinson  King-. 

46.  On  the  Operation  of  Tracheo- 
tomy in  Croup,  performed  at  the 
Children's  Hospital,  and  on  its 
results.  By  B.  A.  Becquerel, 
M.  D.        -        -        -        ■ 

47.  Statistics  of  Dislocations.  By 
M.  Malgaigne.  -        -        - 


475 


475 


476 


-  476 


-  477 


-  477 


-  478 


-  478 


480 


Ophthalmology. 


48.  On  a  peculiar  affection  of  the 
Cornea  in  nurses.  By  Professor 
Nasse.      -        -        -        -        .  481 

49.  Entropion.     By  Dr.   Jacob.   -  481 

50.  Intermittent  Amaurosis.  By 
Dr.  Stoeber.      -        -        -         -  481 

51.  Hereditary  Ptosis.       By   Dr. 


Alessi.      .        -        -        -        - 

52.  Wound  of  the  Orbit — Rupture 
of  the  Optic  Nerve.  By  Mr. 
Phillips.   -        -        -        -        - 

53.  Belladonna  as  a  douche  in 
some  forms  of  Ophthalmic  dis- 
ease.    By  F.  A.  Bulley,  Esq. 


Midwifery. 


482 


482 


483 


54.  Four  children  at  a  Birth.  By 
Dr.  Biggs.         -        -        -  -  485 

55.  Spontaneous  gangrene  of  the 
Cervix  Uteri  and  part  of  the 
Vagina.     By  M.  Baron.     -  -  485 


56.  Occurrence  of  confluent  Small- 
pox in  a  child  before  birth,  with- 
out any  similar  eruption  appear- 
ing on  the  mother,  who  had  been 
vaccinated.     By  Dr.  C.  Gnoli.      485 


Medical  Jurisprudence  and  Toxicology. 
By 


57.  Death    from    Lightning. 
Professor  Carresi.     -         -        .  435 

58.  Unsuccessful  attempt  at  Sui- 
cide.   486 

59.  Spontaneous  Ecchymosis  re- 
sembling external  injury.  By 
Dr.  Lados.         -        -        -        -  486 

60.  Poisoning  with  Verdigris.       -  487 


61.  Poisoning  by  the  liquor  of  In- 
digo Blue.         -        -         .        -  487 

62.  Instant  Death    from  a   wound 

of  the  Stomach.  -        -         -  487 

63.  Dr.  Brett  on  detecting  minute 
portions  of  Arsenic  and  Anti- 
mony.        487 

64.  Signs  of  Maturity  in  new-born 


276 


CONTENTS. 


Children.  -        -        -        - 

65.  Poisoning  by  Sulphuric  Acid 
— detected  in  the  tJrine.  By 
Dr.  Scoffern.     - 

66.  Experiments  on  the  action  of 
hydrated  peroxide  of  Iron  on  Ar- 
senic.    By  M.  Guibert. 

67.  Shall  an  accused  person  be 
allowed  Medical  Counsel? 

68.  Protracted  Gestation. 

69.  Poisoning  of  the  East  India 
Company's  camels  in  Caubul, 
by  Digitalis.      .        -        -        - 

70.  Verguin  on  the  Detection  of 
Copper  in  Medico-legal  Analy- 
sis. - 


PAGE 

489 


-  489 


489 

490 
491 


491 


-  491 


PAGE 

•  492 


-  493 


493 


71.  Ergot.    By  Bonjean. 

72.  On   the   Action   of  Water  on 
Lead.     By  Prof.  Christison 

73.  Feigned      Diseases Bloody 

Urine.        -        -         .        -        - 

74.  Compound     poisoning      with 
Arsenic  and  Opium.  -        -  494 

75.  Absorption  of  various  Mineral 
Poisons.     By  M.  Orfila.    -        -  494 

76.  Corpora  Lutea.     By  Dr.  Wm. 
Davidson.  -        -        -         -  495 

77.  Superfoetation.  By  M.  Dumas.  495 

78.  Connection  of  precipitate  La- 
bour with  Mania.       -         -        -  495 

79.  Antidote  to   Corrosive    Subli- 
mate.    By  M.  Mialhe.       -        -  496 


Organic  Chemistry. 


80.  Organic  Chemistry  applied  to 
Physiology  and  Pathology.  By 
Dr.  Playfair.     -        -        -         -  496 

81.  Azotized  Nutritive  Principles 
of  Plants.     By  M.  Liebig.         -501 

Miscellaneous 

84.  Homoeopathy.  .        _        - 

85.  Destruction  of  the  Medical  Li- 
brary at  Hamburg,  in  the  recent 
conflagration.     -        -        -        - 

86.  Vaudeville  enacted  in  a  Lunatic 
Asylum.    ----- 

87.  Revivification  of  Microscopic 
Animalculae.  By  M.  Milne  Ed- 
wards.      -        -        -        .        - 


82.  Composition  of  Animal    Sub- 
stances.    By  M.  Bouchardat.     -  504 

83.  Analysis     of     the     menstrual 
Fluid.     By  M.  Bouchardat.       -  504 


505:88. 

Health  of  Paris.      - 

-  506 

89. 

Health  of  London. 

-  .506 

90. 

London  Schools.     - 

-  507 

50591. 

University  of  Edinburgh. 

-  507 

92. 

Medical  Faculty  of  Paris. 

-  507 

50593. 

Honours  to  Medical  Men. 

-  507 

94. 

Obituary  Record.    - 

-  507 

95. 

New  French  Medical  Works 

508 

506 

AMERICAN  INTELLIGENCE. 


Mania  from  decayed  Teeth.  By 
Dr.  W^m.  Mendenhall. 

Excision  of  the  upper  Maxillary 
Bone.  By  R.  D.  Mussey,  M.  D., 
&c. 

Ununited  Fracture  of  the  Fore-arm, 
of  four  years'  standing.  By  Dr 
Chas.  S.  Tripler,  U.  S.  A. 

Femoral  Aneurism — Ligature  of 
the  external  Iliac— Death  on  the 
fifth  day.    By  W.  Power,  M.  D. 

Immovable  Apparatus.  By  Dr. 
Geo.  Hayward. 

Fracture  of  the  Patella.  By  Geo 
Hayward,  M.  D. 

Enlargement  of  Bursa  over  Patel- 
la.    By  Geo.  Hayward,  M.  D.  - 

Opium  in  Strangulated  Hernia.  By 
Dr.  A.  B.  Shipman.  - 

Alcohol  detected  in  the  Brain.  By 
Dr.  Lewis.        -        -        -        . 

Leeching  in  Erysipelas.     By  Dr. 


509 


509 


-  510 


511 


-  512 


-  512 


513 


-  514 


Geo.  Hayward.  -        -         -  516 

Subcutaneous  Division  of  the  Mas- 

seter   Muscle.     By   Dr.    .1.    W. 

Schmidt. 516 

Hydrated   Peroxide  of  Iron.      By 

Wm.  Proctor,  Jr.  -  -  -  517 
Oxide  of  Silver.   By  M.  Augustine 

Duhamel.  -        -        -         .  517 

Ligature  of  the  common  Iliac.    By 

Dr.  Edward  Peace.  -  -  -  517 
Dr.  Harris's  case  of  Resection  of 

the  Elbow-joint.  ,  -  -  517 
Substitute  for  a  Warm-bath.     By 


Dr.  Hale.  -        -        -        -  517 

Immovable  Apparatus.  -        -  518 

Connecticut  Medical  Society.  -  518 
Medical    Society   of  the   State   of 

Tennessee.  _  -  -  -  5I8 
Medical  College  of  Georgia.  -  518 
Kemper  College.  -  -  -  518 
515'Ruschenberger's  Natural  History.  518 
lExpulsion. 518 


THE 


AMERICAN     JOURNAL 


OF    THE 


MEDICAL    SCIENCES 


OCTOBER,    1842. 


Art.  I. — Osteosarcoma  of  Lower  Jaw — Amputation — Cure.  By  Charles 
Bell  Gibson,  M.  D.,  of  Baltimore.     [With  two  wood-cuts.] 

Moses  Lee,  blacksmith,  fifty-one  years  of  age,  of  robust  make  and  active 
habits,  a  slave  belonging  to  the  estate  of  the  late  Richard  0.  Grayson,  of 
Loudon  county,  Virginia,  was  placed  in  my  hands  in  April  1842,  for  the 
treatment  of  a  tumour  involving  a  large  portion   of  the   os  maxillare   in- 


ferius.  About  six  years  since, 
whilst  engaged  in  ploughing, 
some  obstacle  occurring  in  the 
course  of  his  furrow,  caused 
the  handle  of  his  plough  to 
be  thrown  violently  upwards,, 
striking  him  severely  in  the 
centre  of  the  chin,  and  produc- 
ing very  severe  pain  in  the 
part  for  a  few  days.  In  less 
than  a  week  afterwards  he 
discovered  a  slight  swelling 
immediately  over  the  spot,  but 
as  the  pain  had  ceased,  he 
paid  little  attention  to  it,  unless 
when  starded  by  a  sponta- 
neous jet  of  blood  which  oc- 
casionally occurred  from  be- 
tween the  first  incisors  of  each 
side.  The  tumour  increased 
slowly,  at  the  end  of  a  year 
No.  VIII.— October,  1842 


Fig.  1. 


3,# 


i    •'!*• 


278  Gibson's  Case  of  Osteo- Sarcoma.  [Oct. 

having  attained  the  size  of  a  hickory-nut.  From  that  period  until  I  saw 
it,  it  increased  more  rapidly,  but  without  pain;  the  only  inconvenience  being 
the  difficulty  of  articulation  and  deglutition.  The  sketch  Fig.  1,  gives  a  faith- 
ful representation  of  his  appearance,  previous  to  the  operation.  The  tumour 
was  confined  to  the  lower  jaw,  having  sprung  apparently  from  the  spot  where 
the  blow  was  received,  directly  in  the  middle  of  the  chin,  and  extending  itself 
with  great  regularity  towards  the  angles  of  the  bone.  The  limit  of  the  dis- 
ease was  evidendy  just  in  front  of  the  first  molar  tooth  on  each  side,  the 
measurement  from  one  point  to  the  other  being  exactly  fourteen  inches. 

In  an  upward  direction  it  extended  nearly  to  the  roof  of  the  mouth,  hav- 
ing pushed  from  their  sockets  all  the  incisors,  the  cuspid,  and  one  of  the 
bicuspids  on  both  sides  of  the  upper  jaw,  and  separating  the  lips  vertically 
to  the  extent  of  four  and  a  half  inches.  Within  the  mouth  and  below,  it 
extended  along  the  under  surface  of  the  tongue  to  the  anterior  border  of  the 
sublingual  gland,  just  in  front  of  which,  the  uniformity  of  the  surface  was 
broken  by  a  rising,  or  lobe,  of  the  size  of  a  black  walnut,  on  which  rested 
part  of  the  under  surface  of  the  tongue.  Over  the  whole  surface  of  the 
tumour,  which  was  intensely  red,  large  veins  were  freely  distributed,  and 
at  points  in  front  were  two  deep  ulcerations,  from  which,  as  well  as  from 
numerous  small  openings,  was  discharged  a  yellowish  sero-purulent  matter, 
small  in  quantity,  and  possessing  but  little  odour.  To  the  touch  the  gene- 
ral impression  was  hard,  though  in  some  places  an  elastic,  and  in  others  a 
decidedly  fluctuating  sensation  was  evident,  especially  in  front,  and  where 
the  tumour  protruded  between  the  lips.  I  performed  the  operation  on  the 
12th  of  April  at  12  o'clock,  in  the  presence  of  a  number  of  the  medical 
men  of  this  city.  I  am  particularly  indebted  to  Drs.  Baxley,  T.  Buckler  and 
Theobald,  for  their  valuable  aid  on  the  occasion. 

The  patient  was  seated  in  an  ordinary  chair,  his  head  supported  by  an 
assistant.  Standing  in  front,  I  made  the  first  incision  three-fourths  of  an 
inch  to  the  left  of  the  median  line  through  the  thickness  of  the  lower  lip 
in  a  straight  line  down  as  far  as  the  diseased  mass  could  be  felt,  an  extent 
of  about  seven  inches.  The  second  incision  was  precisely  similar  at  the 
same  distance  from  the  median  line  on  the  right  side,  thus  leaving  attached 
to  the  tumour  an  inch  and  a  half  in  width  of  lip  and  integuments,  which,  it 
was  thought,  would  be  superfluous  in  the  union  to  be  eflTected  after  the  re- 
moval of  the  tumour. 

A  dissection  was  now  rapidly  made  from  the  point  of  the  first  incision  to 
the  second  molar  tooth;  the  first  molar  on  this  side  was  now  extracted  by 
the  dentist's  key  in  order  to  remove  with  more  facihty  the  bone,  just  ante- 
rior to  the  second  molar,  and  thus  insure,  as  far  as  possible,  the  removal  of 
all  the  diseased  portion.  The  same  course  was  followed  on  the  right  side. 
I  now  took  a  position  directly  behind  the  patient,  his  head  resting  on  my 
breast,  and  the  flap  on  the  left  side  being  held  out  of  the  way,  sawed  from  above 
downwards  through  the  bone  on  that  side,  cutting  through  the  cavity  occu- 


1842.]  Gibson's  Case  of  Osteo- Sarcoma.  279 

pied  by  the  roots  of  the  extracted  molar.  In  the  same  way  the  right  side 
of  the  bone  was  sawn  through.  Coming  again  in  front  and  grasping  the 
mass  with  the  left  hand,  it  was  easily  brought  away  by  dividing  its  connec- 
tions with  the  digastric,  mylo-hyoid  and  genio-hyo-glossus  muscles.  The 
hemorrhage  from  the  cavity  thus  exposed  was  profuse.  The  submental  and 
inferior  coronary  branches  of  the  facial  artery  of  both  sides  were  easily  se- 
cured, but  the  ranineand  sublingual  arteries  gave  us  very  considerable  trouble, 
retiring  out  of  sight,  and  from  increasing  weakness  of  the  patient  giving  a 
scarcely  perceptible  jet.  We  removed  him  into  the  open  air  in  a  yard 
adjoining  the  room,  and  this  with  the  aid  of  some  wine  and  water,  in  about 
twenty  minutes  caused  his  pulse  to  rise,  and  the  bleeding  vessels  were 
secured.  From  the  division  of  the  genio-hyo-glossus  muscle,  considerable 
inconvenience  was  produced  in  the  disposition  in  the  tongue  to  turn  over  and 
point  down  the  pharynx. 

A  ligature  passed  through  the  frasnum  and  secured,  after  the  dressing  of 
the  wound  was  completed,  to  an  iron  wire  contrivance,  remedied  the  incon- 
venience. The  apparatus  consisted  of  an  upright  on  either  side  of  the  head, 
having  a  horizontal  position  on  a  line  with  the  mouth,  and  projecting  some 
three  inches  beyond  it.  A  single  piece  of  iron  wire  was  procured  and  bent 
for  the  purpose.  Having  carefully  examined  and  determined  the  complete 
extirpa^tion  of  the  diseased  bone,  the  edges  of  the  wound  were  brought  to- 
gether an^  retained  by  hare-lip  pins  and  the  interrupted  suture.  Straps 
and  roller  completed  the  dressing,  and  the  patient  was  put  to  bed.  The 
oozing  of  blood  continuing  considerable,  a  piece  of  fine  sponge  was  steeped 
in  the  muriated  tincture  of  iron,  and  introduced  into  the  mouth.  The  dis- 
charge was  then  entirely  arrested. 

Moses  bore  the  operation  extremely  well.  When  put  to  bed  his  pulse 
was  60;  feeble,  but  very  even  and  regular.  During  the  rest  of  the  day  he 
took  occasionally  a  little  very  fluid  barley  water,  finding  considerable  diffi- 
culty in  swallowing.  The  evening  and  night  he  appeared  comfortable,  not 
complaining,  and  sleeping  for  the  most  part.  Two  medical  students  sat  up 
with  him  through  the  night,  and  continued  to  do  so  as  long  as  it  was  neces- 
sary. 

£pril  ISth.  Find  Moses  doing  extremely  well;  I  have  removed  the 
sponge  and  wire  apparatus,  the  disposition  to  swallow  the  tongue  having 
ceased;  pulse  62,  regular;  very  litde  pain  in  the  part.  I  have  removed  him 
to-day  to  a  room  in  my  own  dwelling,  where  I  can  see  him  at  any  time  more 
conveniently.  He  has  taken  to-day  weak  coflee  and  chicken  water,  swal- 
lowing readily  by  means  of  a  catheter  secured  to  a  "  sick  cup."  3  P.  M. 
Pulse  64,  regular. 

14^^.  About  7  o'clock  last  evening  his  pulse  rose  to  80,  without  much 
heat  of  skin.  The  lips  have  become  much  swollen,  with  considerable  heat; 
applied  the  sub.  acet.  plumbi  dilut.,  and  opened  his  bowels  by  a  simple 
enema;  he  slept  well  through  the  night;   this  morning  at  nine  dressed  the 


28a 


Gibson's  Case  of  Osteo- Sarcoma. 


[Oct. 


wound;  it  looks  remarkably  well,  all  below  the  lip  having  united  by  the 
first  intention  except  where  the  ligatures  protrude;  pulse  70;  lip  still  much 
swollen.  3  o'clock  P.  M.  Moses  has  walked  down  stairs,  and  is  now  in 
the  garden;  same  diet.     7  P.  M.   Pulse  74. 

\Uh.  Dressed  the  wound;  very  little  discharge;  lip  continues  much 
swelled  and  presents  quite  a  sulcus  above  the  first  pin.  He  has  been 
down  stairs  nearly  all  day  walking  about;  spirits  good;  appetite  famous. 

16//i.  Passed  a  good  night;  swelling  of  lip  subsiding;  the  upper  pin  came 
away  to-day  in  dressing  the  wound.  He  has  eaten  to-day  a  large  dish  of 
mush  besides  his  soup  and  barley  water. 

llth.  After  dinner  to-day  found  Moses  complaining  a  little  of  weakness; 
perhaps  from  over-exertion  in  walking  about.  Gave  him  some  weak  brandy 
toddy.     10  P.  M.     Stronger;  pulse  70. 

ISth.  Passed  a  very  good  night.  Dressed  the  wound,  and  removed  the 
last  pin;  two  ligatures  came  away  also.     Diet  to-day  oysters  and  beer. 

19;/i.  Passed  last  night  without  having  any  one  with  him.  Dressed  the 
wound  which  has  healed  throughout,  except  at  the  upper  part  of  the  lip  for 
about  the  eighth  of  an  inch.  This  spot  is  improving  under  the  nitrate  of 
silver.     The  other  ligatures  were  pulled  away  to-day. 

26/A.  Moses  has  returned  to  Virginia  to-day.     Nothing  worthy  of  notice 


Fig.  2. 


has  occurred  since  the  last  date. 
He  has  gone  for  the  last  three 
days  without  a  bandage  or  strap 
of  any  kind.  A  thick  line  down 
the  middle  of  his  chin  is  the  only 
evidence  of  his  having  submitted 
to  an  operation.  There  is  very 
little  deformity;  the  thick  integu- 
ments most  naturally  represent- 
ing the  absent  anterior  portion  of 
his  maxilla  inferior. 

Fig.  2,  represents  the  present 
appearance  of  Moses  accurately. 
It  only  remains  to  be  stated,  that 
sections  of  the  removed  tumour 
made  in  various  directions  veri- 
fied in  all  respects  the  description 
of  the  structure  of  osteo-sarcoma. 


Baltimore,  1842. 


gire 


1842.]  Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis.     281 


Art.  II. — On  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis.    By  Chas. 
C.  Hildreth,  M.  D.,  of  Zanesville,  Ohio. 

To  whom  we  are  indebted  for  the  original  introduction  to  the  notice  of  the 
profession,  of  the  black  snakeroot  in  phthisis,  I  am  not  able  to  discover. 
My  attention  was  first  directed  to  it  by  an  article  published  in  one  of  our 
'western  journals  some  eight  or  nine  years  since.     But  as  the  physician 

porting  the  cases  did  not  appear  familiar  with  auscultation,  and,  of  course, 
said  nothing  of  the  pathological  state  of  the  lungs  of  his  patients,  his  com- 
munication on  this  account  lost  much  of  its  interest. 

My  object  here  is  to  direct  the  attention  of  the  profession  to  the  use  of 
the  cimicifuga  in  the  incipient  stage  of  phthisis,  when  that  train  of  constitu- 
tional symptoms  is  induced  by  the  presence  of  induration,  or  tubercle,  in  the 
upper  lobes,  which  even  the  common  observer,  without  a  knowledge  of 
auscultation,  will  but  too  frequently,  and  justly,  pronounce  consumption. 

In  the  latter  stage  of  the  disease,  when  tubercles  are  softened  and  exca- 
vated, and  pus  in  abundance  is  thrown  up,  I  should  not  expect  much  from 
this,  or  any  other  known  treatment. 

Here  it  may  be  asked,  how  are  we  to  distinguish  the  disease  in  its  early 
stage  before  those  pathological  lesions  are  induced  in  the  lungs,  which  ren- 
der it  so  truly  a  disgrace  to  the  healing  art?  Any  modern  treatise  on  auscul- 
tation, will  tell  us  on  what  physical,  as  well  as  rational  signs  to  rely  for  a 
diagnosis. 

Our  best  authors  divide  phthisis  into  three  stages,  in  accordance  with  the 
pathological  lesions: — 

''''The  first  stage  is  that  of  the  formation  of  induration,  whether  granular 
or  diffused.  The  second,  is  that  of  the  conversion  of  those  indurations  into 
yellow  tubercles,  with  the  extension  of  this  lesion  to  other  parts.  The 
third,  is  that  of  their  softening  and  evacuation,  and  the  formation  of  vomica." 

The  more  readily  to  explain  our  views  of  the  treatment  of  phthisis  in  its 
early  stages,  a  few  cases  will  be  reported. 


Case  I.  Phthisis  complicated  with  general  bronchitis.     S.  C ,  aetat. 

45,  of  strong  constitution  and  temperate  habits,  residing  two  and  a  half 
miles  from  Zanesville,  after  atmospheric  exposure,  contracted  bronchitis. 
This  occurred  in  the  early  part  of  May,  1841.  Supposing  that  he  had 
simply  "  taken  cold,"  as  he  expressed  it,  he  continued  to  labour  as  usual  in 
the  open  air,  thus  daily  adding  to  the  disease  of  his  lungs.  After  confine- 
ment to  his  room  and  bed  for  about  three  weeks,  and  having  exhausted  his 
stock  of  domestic  remedies,  he  sent  for  me  to  prescribe  for  him. 

June  \st,  1841.  Found  the  patient  with  all  the  symptoms  of  incipient 
phthisis  complicated  with  most  extensive  bronchitis.     He  was  in  bed,  in 

24* 


282      Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis.   [Oct. 

the  semi-recumbent  posture,  (for  he  could  not  lie  horizontally  on  account  of 
a  sense  of  suffocation,)  and  throwing  up  the  most  profuse  quantity  of  mucus 
and  muco-purulent  expectoration.  For  two  weeks  previously,  he  had  suf- 
fered from  general  febrile  symptoms  during  the  day,  and  perspiration  more 
or  less  profuse  at  night.  His  respiration  was  rapid  and  oppressed;  pulse 
100,  compressible,  and  without  force;  but  giving  to  the  finger  the  sharp 
thrill  of  hectic  irritation.     He  was  rapidly  losing  flesh  and  strength. 

The  expectoration  had  occasionally  during  his  illness  been  mixed  with 
blood,  but  to  no  great  extent. 

The  natural  resonance  of  the  chest  on  percussion  was  found  but  little 
impaired,  except  in  the  subclavian  region  of  the  right  side;  between  which 
and  the  left  a  marked  difference  was  perceptible. 

Auscultation  developed  a  general  mucous  and  sub-mucous  ronchus  in  all 
parts  of  the  chest,  obscuring  in  some  measure  the  natural  respiratory  mur^ 
mur.  Bronchial  respiration,  and  bronchophony,  were  more  distinct  over 
the  right  subclavian  region  than  on  the  left.  My  diagnosis  was  induration 
or  tuberculous  deposition  into  the  apex  of  the  right  lung,  with  perhaps 
general  infiltration  of  miliary  tubercles  throughout  the  substance  of  both 
lungs;  giving  rise  to,  or  sustaining  the  profuse  bronchial  secretion. 

From  the  rational,  and  physical  signs,  I  could  not  doubt  the  development 
of  phthisis  of  a  most  rapidly  exhausting  character.  *'  One  of  the  most 
rapidly  fatal  forms  of  tuberculous  disease,  (says  Dr.  Williams,)  is  that  of 
abundant  miliary  tubercles,  attended  by  a  general  bronchial  inflammation, 
the  secretion  from  which  is  the  chief  cause  of  the  dyspno3a  and  suffocation 
which  ensue." 

As  the  pulse  did  not  indicate  general  depletion,  I  took  blood  by  cups 
from  the  subclavian  regions,  but  more  especially  from  the  right  side,  and 
immediately  rubbed  tartar  emetic  into  the  incisions  from  the  scarificator. 
By  this  means,  I  received  a  freer  suppurating  surface,  and  strong  counter- 
irritation  over  the  diseased  lobes.  To  diminish  the  profuse  expectoration, 
and  allay  in  some  measure  the  almost  constant  cough,  he  was  directed  a 
combination  of  six  grains  of  tartar  emetic,  one  grain  of  morphine,  in  a  pint 
of  strong  decoction  of  cimicifuga  racemosa,  prepared  from  the  fresh  root. 
Of  this  he  was  ordered  a  table-spoonful  every  hour,  the  dose  to  be  increased 
if  not  found  sufficient  to  produce  occasional  vomiting,  when  much  oppressed 
from  the  profuse  secretion  into  the  bronchial  tubes.  He  was  directed  also  to 
take  as  freely  as  his  stomach  would  bear  of  the  decoction  of  the  black  snake- 
root  in  a  separate  state. 

The  proper  attention  was  paid  to  his  diet,  clothing,  and  the  state  of  the 
alvine  secretions. 

2c?.  Found  the  patient  rather  more  comfortable;  still  expectorating  very 
largely,  but  the  cough  not  so  incessant  and  harassing.  He  had  vomited 
several  times  since  my  last  visit,  with  considerable  relief  to  his  respiration; 
pulse  i'5;  surface  lower  in  temperature  and  moist.    Had  his  usual  paroxysm 


1842.]  Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  PulmonaUs.     283 

of  hectic  fever  in  the  evening,  and  perspiration  in  the  night.  Directed  the 
treatment  to  be  continued;  gave  an  alterative  cathartic  during  the  day,  and  at 
night  five  grains  of  acetate  of  lead,  and  three  of  Dover's  powder. 

3c?.  Some  amendment  in  the  symptoms  generally.  Perspiration  not  so 
profuse  at  night,  but  a  continuance  of  the  fever.  Continue  the  cimicifuga, 
but  diminish  the  proportion  of  tartar  emetic.  The  lead  and  Dover's  powder 
at  night. 

bth.  Patient  decidedly  better;  pulse  85;  expectoration  rapidly  diminishing; 
can  resume  the  horizontal  posture  without  inconvenience;  sibilant  and  sub- 
mucous ronchi  in  different  parts  of  the  chest,  and  the  respiratory  murmur 
much  more  distinct  generally.  The  signs  of  induration  in  the  apex  of  the 
right  lung  still  persist.     Continue  treatment. 

Sth,  The  paroxysm  of  hectic  fever,  and  perspiration  at  night,  still  con- 
tinues, notwithstanding  the  subsidence  of  the  bronchial  inflammation. 
Expectoration  still  diminishing;  cough  of  a  more  dry  and  hacking  character, 
pulse  85  in  the  morning,  but  more  rapid  at  night.  With  the  view  of  more 
rapidly  promoting  absorption  of  the  indurations,  he  was  directed  a  solution 
of  ten  grains  of  iodine,  and  twenty  of  hydriod.  potass,  in  an  ounce  of  dis- 
tilled water.  Of  this  he  was  directed  ten  drops  three  times  daily,  in  the 
decoction  of  the  cimicifuga.  Also  the  same  decoction  to  be  taken  in  the 
separate  state  in  as  large  doses  as  the  stomach  will  bear  without  nausea.  To 
secure  sleep,  an  anodyne  to  be  taken  regularly  at  night.  The  pustulation 
with  tartar  emetic  to  be  continued. 

My  patient's  amendment  was  now  quite  rapid;  his  appetite  returned  in  a 
few  days,  and  he  began  to  complain  of  the  farinaceous  diet  to  which  he  was 
restricted;  his  cough  and  expectoration  diminished  daily;  the  hectic  paroxysm 
gradually  disappeared;  his  muscular  strength  gradually  returned,  and  he  took 
exercise  in  the  open  air,  and  on  horseback. 

July  lOth.  Cannot  now  detect  by  auscultation  or  percussion,  any  signs 
of  induration  or  tubercle  in  the  lungs,  nor  has  he  any  of  the  constitutional 
symptoms  of  such  lesions.  The  iodine  and  cimicifuga  were  continued  as 
long  as  the  breathing  remained  hurried  on  any  slight  exertion. 

May  \st,  1842.  The  patient  above  referred  to,  still  remains  free  from  all 
pulmonary  disease. 

That  this  was  not  a  case  of  simple  bronchitis,  or  bronchorrhoea,  may  be 
inferred  from  the  regular  recurrence  of  the  hectic  paroxysm,  which  does  not 
accompany  bronchitis,  when  uncomplicated;  also  from  the  persistence  of  the 
hectic,  after  the  profuse  bronchial  secretion  had  in  a  great  measure  ceased. 
In  simple  bronchitis,  percussion  gives  a  clear  sound  over  the  whole  chest, 
and  particularly  over  the  upper  lobes,  which  are  usually  last,  if  not  least 
affected;  whereas,  in  the  case  reported,  the  upper  lobes  (and  especially  the 
right,)  were  found  dull  on  percussion,  and  remained  so  during  the  greater 
part  of  the  treatment.  That  the  signs  of  induration  were  not  the  result  of 
pneumonia,  may  be  inferred  from  the  absence  of  all  crepitation,  and  the 


284       Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Puhnonalis.    [Oct. 

characteristic  rusty  tinge  of  the  expectoration.  That  this  man  would  have 
died  with  all  the  symptoms  of  phthisis  of  the  most  rapidly  exhausting  cha- 
racter, if  much  longer  neglected,  we  have  good  reasons  for  believing. 

Case  II.  James  M'llvane,  aetat.  23,  of  the  scrofulous  diathesis,  and  of  a 
family  in  which  phthisis  is  hereditary,  consulted  me  concerning  his  cough 
May  5th,  1841.  The  history  of  his  case,  as  detailed  to  me,  is  as  follows: — 
In  the  February  previous,  after  getting  thoroughly  wet  in  a  storm,  he  con- 
tracted bronchitis;  after  recovering  from  the  violence  of  which,  he  found 
himself  subif  ct  to  a  frequent  and  rather  dry  hacking  cough.  As  he  took  no 
remedies,  (being  absent  from  home,)  his  cough  continued  with  him,  and 
the  expectoration  gradually  increased.  In  March  and  April,  he  found  him- 
self getting  feverish  in  the  afternoon,  with  an  occasional  profuse  perspiration 
at  night;  his  breathing  became  more  rapid,  and  oppressed  on  any  slight 
exertion;  he  had  occasional  transient  pains  in  the  chest,  and  all  the  promi- 
nent signs  of  phthisis,  became  marked  and  obvious. 

I  found  him  May  5th,  1841,  with  considerable  febrile  irritation  during 
the  day;  pulse  110,  compressible,  and  without  force;  respiration  hurried  and 
oppressed;  frequent  cough,  with  tolerably  free  mucous  expectoration. 

He  had  a  regular  paroxysm  of  hectic  fever  and  sweat  in  the  night,  which 
left  him  quite  exhausted  in  the  morning.  He  was  rapidly  losing  flesh  and 
strength.  I  was  shown  some  blood  which  he  had  expectorated  during  the 
night  previous,  amounting  perhaps  to  an  ounce,  and  was  informed  that  on 
several  other  occasions  during  his  illness,  he  had  expectorated  small  quan- 
tities. 

Percussion  gave  a  clear  sound  over  the  whole  chest,  except  in  the  subcla- 
vian regions;  and  here  the  sound  was  found  decidedly  more  dull  or  flat  over 
the  left  than  the  right  side. 

By  auscultation,  the  respiratory  murmur  was  found  distinct  in  the  lower 
lobes  of  each  lung,  but  louder  or  more  puerile  over  right  side.  Respiration 
more  distinctly  bronchial  over  the  apex  of  left  lung,  and  here  also  the  sound 
of  expiration  was  nearly  as  loud  as  that  of  inspiration.  Mucous  and  sub- 
mucous ronchus  over  the  upper  lobes  of  each  lung. 

Towards  the  humeral  end  of  the  clavicle  of  the  left  side,  the  resonance  of 
the  voice  was  so  loud  that  at  first  I  supposed  I  had  found  a  cavity;  but  upon 
more  careful  observation  found  the  voice  deficient  in  that  distinct  articulation 
which  characterizes  pectoriloquy.  As  there  was  a  marked  diflerence  in  the 
sounds  of  respiration  and  resonance  of  the  voice,  between  corresponding 
parts  of  the  chest,  I  came  to  the  diagnosis  of  induration,  or  tubercle  in  the 
apex  of  the  left  lung,  and  perhaps  also  of  the  right. 

The  same  general  plan  of  treatment  was  followed  in  this  case  as  in  the 
last.  He  was  directed  the  free  use  of  the  cimicifuga  in  decoction;  and  to  a 
pint  of  the  same  four  grains  of  tartar  emetic  and  one  of  morphine  were  added. 
Of  this  he  was  ordered  a  table-spoonful  every  two  hours. 


1842.]  Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Fulmonalis.     285 

Tartar  emetic  was  applied  to  the  subclavian  regions  until  pustulation  fol- 
lowed; the  bowels  were  attended  to,  and  the  proper  diet  and  clothing  directed. 

At  the  expiration  of  a  week  the  pulse  had  come  down  to  near  the  natural 
standard;  the  cough  was  much  better,  and  the  febrile  symptoms  had  nearly- 
disappeared.  For  the  purpose  of  more  rapidly  promoting  absorption  of  the 
induration  or  tubercles,  he  was  now  directed  the  solution  of  iodine,  and 
hydriodate,  with  the  cimicifuga,  in  the  same  manner  and  quantity  as  in  the 
last  case. 

His  recovery  was  rapid  and  uninterrupted.  Stimulating  frictions  to  the 
surface,  and  exercise  in  the  open  air  were  of  much  service  in  restoring  his 
strength. 

The  iodine  and  cimicifuga  were  continued  as  long  as  his  breathing  re- 
mained short  on  any  slight  exertion.  He  is  now.  May  5th,  1842,  perfectly 
free  from  all  pulmonary  disease,  and  in  robust  health. 

Case  HI.  Phthisis  complicated  ivith  pneumonia  and  slight  pleuritis. — 
Was  requested  to  visit  Mrs.  Wm.  M'Clellan,  setat.  21,  on  May  19th,  1841. 
On  inquiry,  I  ascertained  that  she  had  been  troubled  with  a  rather  dry,  hack- 
ing cough,  for  some  six  or  eight  weeks  past,  with  occasional  febrile  symp- 
toms, but  had  suddenly  become  much  worse  after  getting  her  feet  wet.  I 
found  her  coughing  frequently  and  violently;  expectoration  viscid,  and  rusty, 
with  an  occasional  intermixture  of  blood.  She  had  a  slight  stitch,  on  full 
inspiration,  over  the  right  lateral  region;  pulse  110,  rather  full  and  hard; 
respiration  32,  and  oppressed.  Percussion  yielded  a  dull  sound  over  the 
right  lateral  and  subclavian  regions.  Respiration  puerile  over  the  whole 
lung,  except  its  apex,  where  the  submucous  and  subcrepitant  rales  were 
occasionally  heard;  respiratory  murmur  very  much  obscured  over  the  right 
lateral  region;  distinct  crepitation  over  the  middle  and  upper  lobes  of  the 
right  lung  with  bronchial  respiration  and  bronchophony.  The  usual  signs 
of  slight  pleuritic  effusion  v/ere  all  present  in  the  right  lateral  region.  My 
patient's  pulse  justifying  the  measure,  I  immediately  drew  blood  to  ap- 
proaching syncope,  with  decided  relief  to  her  respiration.  Six  grains  of 
tartar  emetic  and  one  of  morphine  were  dissolved  in  a  pint  of  the  cimicifuga 
decoction,  of  which  a  dose  sufficient  to  produce  nausea  and  occasional  vomit- 
ing, was  directed  every  two  hours.  A  blister  sufficiently  large  to  cover  the 
pleuritic  effusion,  and  an  alterative  cathartic  at  night  were  also  prescribed. 

•2Qth.  Found  her  better  in  all  respects.  She  still,  however,  had  a  slight 
stitch  on  full  inspiration.  Knowing  her  hereditary  predisposition  to  plithisis, 
(for  she  was  a  sister  of  the  gendeman  whose  case  was  last  reported,)  I 
determined  as  soon  as  possible  to  subdue  the  inflammation  of  the  lungs  and 
pleura,  and  bled  her  again  to  approaching  syncope. 

The  tartar  emetic  was  continued  internally  as  before  directed,  and  applied 
externally  over  the  subclavian  spaces. 


286      Hildreth  on  Cimidfuga  and  Iodine  in  Phthisis  Pulmonalis,   [Oct. 

21s^. — Still  improving;  no  stitch  on  full  inspiration;  expectoration  becom- 
ing less  viscid  and  rusty,  and  more  decidedly  mucous;  continue  treatment. 

25/A. — There  are  to-day  no  signs  of  pleuritic  effusion:  the  crepitous 
rale  has  disappeared  from  all  parts  of  the  chest,  and  the  natural  vesicular 
murmur  in  a  great  measure  returned.  She  still  has  cough,  and  mucous  ex- 
pectoration; and  in  the  upper  lobes  the  signs  of  bronchial  irritation  are  still 
present. 

As  usual  in  acute  inflammation  of  the  lungs  and  pleura,  she  has  had  more 
fever  at  night  than  during  the  day;  and  occasionally,  her  fever  has  gone  olf 
by  profuse  perspiration;  and  now,  notwithstanding  the  disappearance  of  the 
signs  of  inflammation  in  the  parenchyma  and  serous  membrane,  the  parox- 
ysm of  fever  in  the  evening,  and  perspiration  in  the  night  still  continues. 
Percussion,  and  the  sounds  of  the  voice,  and  respiration  still  indicate  in- 
creased solidification  of  structure  in  the  apex  of  the  right  lung. 

Now  this  increase  of  density,  must  either  originate  in  one  of  the  products 
of  inflammation  of  the  parenchyma,  viz.,  as  hepatization,  or  must  be  traced 
to  previous  deposition  of  indurated  matter  or  tubercle.  That  it  is  not  the 
result  of  the  pneumonia,  I  infer  from  the  fact  that  the  inflammation  was 
not  very  violent  or  extensive;  and  being  attacked  as  soon  as  developed,  and 
yielding  promptly  to  treatment,  there  had  scarce  been  time  for  it  to  pass  into 
the  second  stage.  As  pneumonia  almost  invariably  attacks  first  the  middle 
and  lower  lobes  of  the  lungs,  we  would  naturally  expect  them  to  suffer  at 
least  equally,  with  the  upper;  and  hence,  if  the  increase  of  density  was 
from  hepatization,  we  should  expect  it  to  be  much  more  extensive.  Again, 
during  the  continuance  of  hepatization,  if  any  progress  was  making  in  its 
resolution,  we  should  expect  to  find  the  characteristic  rusty  and  viscid  ex- 
pectoration, and  also  more  or  less  crepitation.  These  signs  and  symptoms 
of  hepatization  being  absent,  and  in  their  stead,  finding  those  of  phthisis  in 
its  incipient  stage,  and  these  too  occurring  in  a  scrofulous  subject,  in  whose 
family  the  disease  may  be  considered  hereditary;  the  diagnosis  was  to  my 
mind  clearly  established. 

May  28th. — The  symptoms  of  phthisis  still  persisting,  notwithstanding 
the  subsidence  of  acute  inflammation  under  treatment,  I  again  directed  the 
iodine  solution  with  the  cimicifuga  in  the  same  manner  as  before  detailed: 
its  influence  was  most  happy:  within  a  week  the  patient  was  decidedly  con- 
valescent; the  pulse  came  down  to  near  the  natural  standard;  the  hectic  fever 
soon  disappeared  entirely,  and  with  it  the  cough  and  all  other  signs  of  phthi- 
sis. Her  appetite  improved,  and  she  was  not  so  carefully  restricted  in  its 
indulgence.  As  her  strength  returned,  she  took  exercise  in  the  open  air,  on 
horseback. 

Stimulating  frictions,  warm  clothing,  change  of  air,  &c.,  soon  restored  her 
to  health.  The  iodine  and  cimicifuga  were  continued  until  her  convalescence 
was  fairly  established,  or  until  that  shortness  of  breath  so  common  in  phthi- 
sis, had  ceased  to  trouble  her. 


1842.]  Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis,     287 

She  is  now,  May  5,  1842,  free  from  all  pulmonary  disease,  and  in  per- 
fect health. 

Many  other  cases  of  a  similar  character  might  be  reported,  did  the  limits 
of  this  paper  permit;  but  we  deem  these  sufficient  to  illustrate  the  general 
plan  of  treatment  pursued.  As  in  phthisis,  we  find  a  great  variety  of  causes, 
symptoms,  and  complications;  so  in  its  management  must  our  remedies  vary 
to  meet  existing  indications.  Nor  should  we  rest  satisfied  with  the  mere 
removal  of  the  lesions  of  phthisis  from  the  lungs,  however  limited  they  may 
have  been;  but  should  remember,  that  this  disease  when  once  developed  rea- 
dily becomes  a  constitutional  affection,  that  the  fluids  and  solids  become  con- 
taminated, and  we  have  but  little  security  against  the  deposition  of  tubercle 
in  other  organs.  Hence  constitutional  treatment  is  of  the  utmost  moment. 
To  render  this  effective,  the  purest  air  should  be  selected  for  our  patient,  and 
if  his  circumstances  will  permit,  such  a  climate  as  will  justify  him  in  taking 
regular  and  sufficient  exercise  in  the  open  air;  his  diet  should  be  as  nutri- 
tious as  the  digestive  organs  can  assimilate,  without  too  much  exciting  the 
arterial  system.  Such  remedies  as  give  tone  to  the  system,  and  promote  the 
healthy  functions  of  all  the  organs;  proper  clothing,  and  frictions  to  maintain 
the  healthy  function  of  the  skin;  these  are  the  means  indicated  to  invigorate 
the  constitution,  and  enable  it  to  throw  off"  disease,  or  prevent  its  reinva- 
sion  of  the  lungs  or  other  organs. 

The  practice  of  daily  sponging  the  chest  with  cold  water,  or  a  spirituous 
solution  of  common  salt,  will  tend  to  prevent  that  susceptibility  to  catarrhal 
aflfections,  which  in  some  constitutions  leads  directly  to  phthisis.  Should 
tonics  of  any  kind  be  indicated  in  the  treatment  of  this  disease,  the  prunus 
virginiana  will  be  found  least  irritating  among  the  vegetable  bitters,  and  from 
the  mineral  kingdom,  the  iodide  of  iron  will  prove  most  beneficial,  especially 
in  anemic  or  chlorotic  subjects 

With  a  few  remarks  on  the  general  character  of  the  cimicifuga,  we  will 
close  this  communication. 

It  is  much  to  be  regretted  that  the  medicinal  qualities  of  the  black  snake- 
root  are  not  more  accurately  defined.  While  some  authors  ascribe  to  it 
"deobstruent  and  narcotic  properties,"  others  consider  it  a  "  slight  tonic, 
possessing  also  the  property  of  stimulating  the  secretions  of  the  skin,  kid- 
neys, and  pulmonary  mucous  membrane."  It  is  chiefly  employed,  say 
*'Wood  and  Bache,"  in  "  rheumatism,  dropsy,  hysteria,  and  various  affec- 
tions of  the  lungs;  particularly  those  resembling  consumption.''^  Dr.  Ger- 
hard, in  speaking  of  its  use  in  rheumatism,  styles  it  a  slight  narcotic,  possess- 
ing some  diaphoretic  and  alterative  properties. 

That  it  has  narcotic  properties,  somewhat  similar  to  those  of  colchicum, 
veratrum  album,  or  digitalis,  we  cannot  for  a  moment  doubt,  after  observing 
its  influence  on  the  brain,  stomach,  vascular  and  nervous  systems.  Thus  a 
a  large  dose  of  the  strong  decoction  or  tincture,  will  produce  vertigo,  and 
impaired   vision,  nausea  and  vomiting,  reduce  the  action  of  the  heart  and 


288       Hildreth  on  Cimicifuga  and  Iodine  in  Phthisis  Pulmonalis.   [Oct, 

arteries,  and  induce  perspiration.     Its  influence  in  diminishing  nervous  irri- 
lability  or  involuntary  muscular  action,  is  very  obvious  in  chorea. 

That  it  is  not  a  narcotic  of  very  active  or  violent  character,  may  be  infer- 
Ted  from  the  quantity  of  the  decoction  which  can  be  borne  without  inducing 
decided  or  alarming  narcotism.  We  have  known  a  pint  of  the  strong  decoc- 
tion (made  from  two  ounces  of  the  root)  taken  in  the  course  of  two  hours 
by  an  adult.  The  consequences  were  vertigo,  impaired  vision,  two  or  three 
effectual  efforts  at  vomiting  and  perspiration;  but  no  alarming  narcotism  or 
prostration.     Its  influence  on  the  urinary  organs  was  not  noticed. 

The  saturated  tincture  possesses  far  more  active  narcotic  powers,  and  re- 
quires much  more  caution  in  its  exhibition;  from  one  to  two  drachms  will 
be  found  a  full  dose  for  an  adult.* 

In  chorea  we  have  given  the  strong  decoction  with  aromatics,  (when  much 
objection  is  made  to  its  nauseous  taste,)  also  the  saturated  tincture,  or  the 
powder  of  the  dried  root:  and  by  thus  varying  that  form  of  exhibition,  we 
often  secure  its  continuance  for  a  much  longer  period,  than  if  one  preparation 
alone  were  used. 

In  phthisis,  we  prefer  the  decoction  of  the  fresh  root,  because  it  contains 
mucilage,  is  very  readily  prepared,  and  is  free  from  the  stimulating  influence 
of  the  alcohol  in  the  tincture. 

We  direct  the  patient  as  large  a  dose  as  the  stomach  will  bear  without  in- 
ducing vomiting,  every  two  or  three  hours  when  awake;  and  make  it  the 
vehicle  for  the  exhibition  of  whatever  other  remedies  the  peculiarity  of  the 
case  may  require. 

In  acute  phthisis,  uncomplicated  with  much  inflammation  in  the  vesicular 
structure,  or  pulmonary  mucous  or  serous  membranes,  we  have  often  seen 
the  most  prompt  action  of  the  decoction  alone,  in  throwing  off  febrile  excite- 
ment or  the  hectic  paroxysm,  allaying  cough,  reducing  the  rapidity  and 
force  of  the  pulse,  and  inducing  gentle  perspiration.  In  those  intercurrent 
congestions  and  inflammations,  so  frequent  in  the  second  and  third  stages 
of  phthisis,  from  atmospheric  exposures,  we  have  often  seen  the  same  happy 
influence  exerted.  When  tubercles,  however,  are  softened  down  and  exca- 
vated, we  have  been  disappointed  in  effecting  permanent  cures  by  this,  and 
all  other  known  remedies. 

That  iodine  in  combination  with  various  bases,  possesses  unequivocal  powers 
in  promoting  absorption  or  resolution  of  tubercle  or  induration,  we  have  the 
evidence  of  such  names  as  Baron,  Morton,  Williams,  and  many  others. 
That  the  inhalation  of  iodine  and  conium,  as  directed  by  Scudamore,  will 
prove  a  valuable  adjuvant  in  the  dispersion  of  the  early  lesions  of  phthisis, 
we  cannot  for  a  moment  doubt;  but  practically  cannot  speak  of  its  efficacy. 


*  My  father,  Dr.  S.  F.  Hildreth  of  Marietta,  informs  me  that  he  prefers  the  saturated 
tincture  of  the  cimicifuga,  to  the  lobelia,  as  an  antispasmodic  in  asthma.  The  dose  is 
nearly  the  same  as  that  of  the  lobelia  in  tincture. 


J 


1842.]  Gibbes  on  Typhoid  Pneumonia.  289 

We  have  not  ventured  to  give  any  of  the  preparations  of  iodine,  in  phthi- 
sis, until  as  far  as  possible  we  have  removed  all  signs  of  inflammation  from 
the  lungs  or  pleura,  by  antiphlogistic  or  other  means;  and  have  then  given 
it  with  full  doses  of  the  cimicifuga,  that  its  stimulant  influence  might  not  be 
felt  injuriously. 

In  this  manner  of  exhibition  it  has  almost  uniformly  improved  the  appe- 
tite and  nutritive  function;  diminished  febrile  irritation  and  cough;  and  in 
all  respects  acted  favourably;  indeed  we  have  in  numerous  instances  been 
surprised  at  the  prompt  and  permanent  restoration  of  our  patients,  under 
its  use,  from  a  state,  as  we  believed,  of  well  developed  phthisis  to  perfect 
health. 


Art.  III. — On  Typhoid  Pneumonia,  as  it  occurs  in  the  neighbourhood  of 
Columbia,  S.  C.     By  R.  W.  Gibbes,  M.  D.,  of  Columbia,  S.  C. 

This  disease  prevails  extensively  during  the  winter  months  on  our  river 
swamp  plantations,  and  destroys  more  negroes  than  all  others  combined,  to 
which  they  are  ordinarily  liable.  It  is  a  matter  ot'  surprise,  that  so  little 
has  been  published  in  relation  to  it.  In  the  whole  series  of  the  American 
Medical  Journal,  there  is  but  a  single  communication  on  the  subject,  and 
that  is  of  an  epidemic  which  prevailed  in  the  west,  and  was  confined  chiefly 
to  whites.  Having  for  eight  years  been  familiar  with  this  affection  in 
attendance  upon  a  large  number  of  negroes  on  the  plantations  in  this  neigh- 
bourhood, I  have  thought  that  an  account  of  my  exp&rience  with  it  might 
be  interesting. 

I  would  here  premise,  that  I  am  fully  impressed  with  the  conviction 
that  the  treatment  of  disease  with  negroes  must  diflfer  much  from  that 
of  whites.  The  negro  lives  a  life  of  constant  exercise,  and  exposure  to 
changes  of  weather;  he  uses  a  diet  seldom  varying;  he  has  a  fixed  and  certain 
amount  of  labour  to  practise,  and  he  usually  indulges  in  no  excesses.  The 
action  of  his  system  is  more  equable;  his  nervous  power  is  more  regularly 
distributed,  and  the  various  functions  of  the  organs  are  less  apt  to  be  impeded 
than  with  whites  who  live  more  or  less  irregularly.  Negroes  sufl^er  more 
from  the  diseases  of  cold  weather,  and  but  little  from  heat;  they  are  less  lia- 
ble than  whites  to  inflammatory  affections;  inflammation  is  not  so  active,  and 
is  much  more  readily  controlled  with  them;  they  are  more  easily  brought 
under  the  influence  of  medicine;  hence  their  diseases  are  more  curable.  I 
speak  of  plantation  negroes; — those  who  are  employed  in  domestic  attend- 
ance on  families  and  in  cities,  differing  in  their  habits,  have  their  complaints 
No.  VIII.—OcTOBER,  1842.  25 


290  Gibbes  on  Typhoid  Pneumonia.  [Oct. 

modified  by  their  employments,  and  assimilate  more  to  the  condition  of  the 
whites.  Under  similar  circumstances,  a  single  bleeding  followed  by  one  or 
two  doses  of  medicine,  M'^ill  control  a  case  of  acute  pleurisy  in  a  negro,  while 
three  or  four  times  as  much  bleeding  and  treatment  will  be  required  by  a 
white  man  of  apparently  similar  strength.  Negroes  bear  depletion  badly, 
and  stimulants  well.  Opiates  produce  more  decidedly  beneficial  efi'ects  on 
them  than  on  whites,  and  much  less  injury  or  unpleasant  consequences. 

The  disease  of  which  I  write  is  known  by  various  names,  according  to 
the  predominance  of  particular  symptoms.  The  more  violent  cases  being 
suddenly  taken  with  a  chill  and  cold  skin,  and  dying  often  without  any 
reaction,  it  is  sometimes  spoken  of  as  the  Cold  plague.  The  head  being 
almost  always  affected,  and  before  the  pneumonic  symptoms  are  developed, 
it  is  called  Head  pleurisy;- — and  symptoms  of  prostration  and  continued 
debility,  with  pain  in  the  chest,  and  cough  being  usually  present,  the  term 
Typhoid  pneumonia  is  most  commonly  applied  to  it  by  physicians.  In 
the  fall  or  spring,  when  bilious  symptoms  exist,  it  is  called  Bilious  pleurisy. 

It  occurs  during  the  prevalence  of  long-continued  cold  spells,  and  more 
frequently  with  rains.  It  is  rarely  found  on  highland  plantations,  and  if  at 
all,  is  confined  to  such  negroes  as  are  more  or  less  exposed  to  work  on  low 
and  wet  grounds.*  On  swamp  plantations  the  disease  is  epidemic,  but  as 
far  as  my  experience  extends,  I  have  known  but  few  cases  on  upland  settle- 
ments. I  have  seen  most  cases  in  January  and  February,  although  it  often 
commences  in  November  and  continues  through  April.  During  the  past 
winter,  the  weather  has  been  unusually  variable,  with  much  rain,  but  so  lit- 
tle intense  cold  that  there  was  no  iee  continuing  for  more  than  a  day  or  tw^o, 
and  none  thick  enough  to  be  preserved.  On  the  plantations  under  my 
charge,  where  there  are  about  twelve  hundred  negroes,  there  have  been  fewer 
cases  than  usual — in  all  probably  not  over  fifty;  while  last  year,  on  one  place, 
among  three  hundred  there  were  seventy-two  cases,  and  on  another  forty- 
seven  among  a  hundred  and  fifty. 

Old  negroes,  and  such  as  are  weak  from  any  previous  disease,  are  more 
liable  to  be  attacked.  Children  under  ten  years  are  not  often  aff*ected;  yet  I 
have  known  several  cases  of  five  or  six  y-ears  of  age,  where  death  has  been 
sudden  with  similar  symptoms  as  in  the  adults;  these  have  usually  been 
such  cases  as  the  old  women  call  wormy — children  of  weakly  constitutions, 
who  have  sufifered  more  than  others  from  worms.  When  such  cases  are 
attacked,  they  rarely  recover. 

Where  the  disease  is  violent  in  its  attack,  the  patient  suddenly  becomes 
cold  and  pulseless,  lethargic,  and  often  insensible  without  previous  com- 
plaint; and  I  have  known  cases  found  dead,  or  die  within  three  or  four 
hours  from  being  apparently  well. 

*  I  understand  this  disease  hus  prevailed  during  the  past  winter  in  the  upper  districts 
of  S.  C,  and  been  very  fatal;  what  the  type  of  the  disease  was  I  am  not  informed. 


1842.]  Gibbes  on  Typhoid  Pneumonia.  291 

^''January  I2th,  1842.  I  was  sent  for  to-day  to  see  a  case  which  I  found 
in  articulo  mortis — January,  aetat.  32,  strong  and  active;  ploughed  yesterday 
until  12  M.;  felt  badly;  had  pain  in  head  and  chest;  came  home;  was  very 
giddy;  skin  cold,  and  pulse  very  small  and  quick;  sinapisms  were  applied 
to  the  extremities,  and  a  blister  to  the  chest;  a  dose  of  ipecac,  was  given  to 
him  by  the  overseer;  he  vomited  freely,  but  no  reaction  came  on.  I  found 
him  at  11  A.  M.  with  a  cold  skin,  threadlike  pulse,  breathing  quick;  com- 
plained of  pain  over  the  eyes;  his  intellect  perfectly  clear;  tongue  red  at  the 
edges,  covered  with  a  dry  brown  crust;  throat  and  mouth  dry  and  parched, 
with  sordes  about  the  teeth;  chest  clear  over  its  whole  extent;  extremely 
feeble.  Hot  applications  and  frictions  had  no  effect  on  his  skin;  carbonate 
of  ammonia  and  whiskey  toddy  had  no  influence  on  his  pulse;  he  died  at  6 
P.  M." 

In  this  ease  the  patient  seemed  to  die  from  an  absolute  and  direct  pros- 
tration of  nervous  power;  and  the  clearness  of  intellect  was  a  remarkable 
symptom 

*'/an.  30^^.  I  was  called  to  a  case  taken  last  night  late  with  chill  and 
cold  skin;  pulseless;  pain  in  head;  lethargic;  unable  to  move  himself;  he  had 
sinapisms  and  pepper  tea,  (^infusion  of  capsicum);  was  dead  at  10  A.  M. 
when  I  reached  him." 

"  Bob,  aetat.  35,  was  apparently  well;  about  12  M.  said  he  felt  cold  and 
weak;  the  overseer  sent  for  me,  a  distance  of  seven  miles;  I  reached  him  in 
about  four  hours,  he  was  then  dead."  Several  other  cases  of  the  disease  were 
on  this  place,  at  this  time,  of  mild  form;  others  more  severe  occurred  after- 
wards; I  did  not  for  a  moment  doubt  that  he  died  from  it.  I  have  frequently 
been  called  to  cases  of  twelve  to  twenty  hours'  standing,  and  found  them 
dying. 

"  Nat,  aetat.  55,  worked  in  the  field  and  did  his  full  task;  came  home  in 
the  evening  well;  sat  by  the  fire  and  talked  as  usual;  about  9  P.  M.  com- 
plained of  feeling  weak  and  cold;  the  nurse  was  not  called  to  him;  he  was 
covered  with  blankets,  and  remained,  as  was  supposed,  asleep  until  morn- 
ing; I  was  then  called  to  see  him;  found  him  cold,  insensible;  pulseless;  the 
nurse  had  given  him  warm  pepper  tea,  (which  is  much  used  as  a  stimulant 
and  diaphoretic  by  the  old  nurses);  he  swallowed  with  difficulty;  I  directed 
cataplasms  of  mustard  and  frictions  of  hot  turpentine,  with  whiskey  and 
water  internally.  After  a  few  hours  he  was  roused;  feeble  reaction  came  on; 
his  pulse  never  became  full;  I  directed  the  whiskey  toddy  to  be  continued 
with  two  grains  of  quinine  every  third  hour.  He  improved  for  several 
days,  but  continued  very  feeble;  gained  a  little  strength;  was  able  to  sit  up 
for  a  short  time;  his  tongue  was  red  at  the  edges,  with  a  dry  brown  crust; 
became  moist  after  three  or  four  days;  an  occasional  laxative  was  given  him, 
but  whiskey  and  quinine  and  soup  were  constant  prescriptions.  I  consi- 
dered him  doing  well,  and  slowly  convalescing;  no  pneumonic  symptoms, 


292'  Gibbes  on  Typhoid  Pneumonia.  [Oct, 

but  a  very  slight  cough  appeared;  a  cold,  rainy  change  of  weather  came  on; 
on  that  night  he  had  a  chill,  and  died  in  a  few  hours." 

Frequently  have  I  known  cases  convalescent,  able  to  walk  about,  free 
from  all  symptoms  but  debility,  yield  suddenly  to  a  cold  change  of  weather, 
and  die  in  a  few  hours — or  linger  several  days  with  pneumonic  symptoms. 
If  a  case  has  been  much  enfeebled  by  a  first  attack,  a  second  is  very  likely 
to  prove  fatal.  A  cold  and  windy  change  often  aggravates  symptoms  which 
were  mild  and  favourable.  On  one  occasion,  I  left  five  cases  doing  well, 
with  no  serious  symptoms;  a  very  cold  drizzling  rain  set  in  towards  even- 
ing;— on  my  visit  next  morning,  I  found  three  of  them  with  all  the  symp- 
toms worse;  one  died  on  that  day,  seemingly  of  debility;  the  others  were 
kept  up  by  strong  stimulants,  and  large  doses  of  quinine.  One  of  them  con- 
tinued very  feeble  for  several  weeks;  a  large  abscess  formed  on  the  leg 
which  was  opened;  it  discharged  very  freely,  and  so  exhausted  her  that  her 
strength  could  not  be  kept  up  by  tonics  and  stimulants,  and  she  died  on  the 
next  day. 

The  following  case  is  a  fair  specimen  of  the  severe  form  of  the 
disease  at  its  commencement,  and  is  a  good  illustration  of  my  view  of  the 
treatment  required.  I  would  premise  here  that  I  have  known  venesection 
practised  frequently  in  the  cold  stage,  and  I  have  never  seen  a  case  recover, 
and  rarely  even  if  used  after  reaction.  On  one  plantation,  a  few  years  ago, 
the  five  first  cases  which  occurred  of  this  disease  commencing  with  pain  in 
the  head  and  chest,  were  bled  by  the  overseer  who  undertook  their  treat- 
ment;— every  case  terminated  fatally.  He  became  satisfied  that  some  other 
treatment  was  necessary.  I  was  sent  for,  and  introduced  the  treatment  by 
stimulants,  opiates  and  revulsives,  and  twenty-three  cases  which  I  had  under 
treatment  all  recovered.  In  this  disease,  if  the  cases  are  immediately  attended 
to,  it  is  found  quite  manageable,  as  much  so  as  an  ordinary  catarrh;  but  if 
neglected  for  twelve  or  twenty-four  hours,  and  the  symptoms  are  at  all 
aggravated,  they  are  very  apt  to  die. 

"  Sunday,  February  ISth,  1842.  Bess  complained  last  night  of  head- 
ache; did  not  sleep  well;  early  this  morning  was  seen  by  the  nurse;  was 
drowsy;  complained  of  pain  over  the  eyes;  pulse  was  small  and  skin  cold; 
whiskey  and  infusion  of  capsicum  had  been  given,  and  sinapisms  applied  to 
the  extremities.  I  found  her  at  10  A.  M.  with  skin  cooler  than  natural, 
though  not  cold;  is  now  sensible,  but  very  giddy  upon  any  attempt  to  raise 
her  head;  complains  of  severe  pain  over  the  eyes;  pulse  is  small  and  irrita- 
ble, 100  by  the  watch;  feels  very  week;  tongue  is  red,  looks  like  raw  beef; 
very  dry;  breathing  rather  slow;  no  cough  nor  pain  in  the  chest.  I  directed 
2  grs.  camphor,  2  grs.  calomel,  and  5  grs.  Dover's  powder  every  two  hours, 
until  three  doses  were  given;  and  the  whiskey  toddy  in  small  quantities 
every  hour,  unless  the  skin  became  hot,  and  after  three  powders  if  the  skin 
was  not  so,  to  continue  them  every  third  hour  until  next  day,  with  a  tea-cup 
of  warm  serpentaria  infusion  after  each  dose. 


1842.]  Gibbes  on  Typhoid  Pneumonia.  293 

**0n  Monday  I  saw  her,  and  found  her  free  from  headache;  had  slept 
well;  skin  was  in  good  condition;  soft  and  natural;  pulse  80.  She  had  taken 
six  powders;  after  the  third,  she  had  sweat  freely,  and  her  headache  then  went 
off;  her  tongue  was  now  moist,  and  with  a  whitish  fur,  paler  at  the  edges; 
feels  much  better,  but  is  weak.  I  directed  serpentaria  and  epsom  salts  to 
be  given  this  morning,  and  a  full  opiate  at  night.  On  the  next  day  she  was 
convalescent." 

Such  cases  as  this  are  very  common,  and,  where  the  nervous  power  is 
soon  roused,  and  its  tone  restored  by  opium,  camphor,  &c.,  and  diffusible 
stimuli  excite  the  circulation  and  restore  free  capillary  action,  no  pneumonic 
symptoms  appear.  Where  the  nervous  system  is  in  a  depressed  state,  and 
an  effort  at  reaction  is  unsuccessful  from  a  want  of  nervous  energy  in  the 
spinal  nerves  and  those  of  respiration,  congestion  of  the  lungs  takes  place, 
which  continuing,  gives  rise  to  pneumonic  inflammation;  the  vascular  ful- 
ness arising  altogether  from  nervous  debility. 

I  consider  typhoid  pneumonia  among  negroes  as  an  adynamic  disease,  in 
which  the  nervous  energy  of  the  patient  is  directly  debilitated  by  the  seda- 
tive influence  of  cold.  If  reaction  takes  place,  the  nervous  system  must  be 
braced  up  and  kept  steady,  while  such  means  are  used  to  control  local  inflam- 
mation as  will  not  reduce  the  general  strength.  The  disease  is  then  one  of 
irritation  and  not  of  inflammation.  The  tendency  to  sink  is  so  great  that 
general  depletion  is  highly  injurious,  and  local  bleeding  must  be  practised 
with  great  caution.  Small  doses  of  calomel  as  a  general  excitant  of  the 
secretions,  with  camphor  and  opium,  and  with  much  debihty  carbonate  of 
ammonia  and  alcoholic  stimuli  producing  diffusion,  and  free  vesication,  are 
the  important  indications  required.  Laxatives  and  not  cathartics  aid  mate- 
rially in  the  treatment. 

The  following  cases  are  examples  of  the  mild  form  of  the  disease. 

^^  Feb.  lU/i,  1842.  Chance,  aetat.  13,  complains  of  pain  in  the  head 
over  the  eyes,  is  giddy;  skin  dry,  but  of  ordinary  temperature;  tongue 
sHghtly  furred,  redder  than  natural;  no  cough;  pulse  small,  soft,  quick,  130 
by  the  watch;  breathing  natural.  I  directed  calomel  2  grs.,  Dover's  pow- 
der 10  grs.,  to  be  given  and  repeated  in  two  hours;  each  dose  to  be  followed 
by  warm  infusion  of  serpentaria;  as  soon  as  he  sweats,  stop  the  powders; 
early  to-morrow  give  him  a  dose  of  calcined  magnesia. 

"  12^/i.  Is  much  better;  pulse  below  100;  sweat  freely  yesterday;  slept 
well;  pain  in  the  head  very  slight;  skin  soft.  I  prescribed  the  continuance 
of  the  infusion  of  serpentaria,  with  8  drops  of  laudanum  every  third  hour 
until  bed-time. 

"  13^/i.  Is  convalescent;  pulse  80." 

''^  Feb.  Wth.  Sally,  a3tat.  11,  has  pain  over  the  eyes;  cough  and  pain  in 
the  chest;  pulse  small,  140,  soft;  nostrils  run  freely;  breathing  hurried;  is 
weak,  and  seems  distressed.     I  prescribed  calomel  2  grs.,  Dover's  powder 

25* 


294  Gibbes  on  Typhoid  Pneumonia,  [Oct. 

5  grs.  every  third  hour,  with  infusion  of  serpentaria;  she  had  taken  in  the 
morning  salts  which  had  operated  three  times. 

"  I2th,  I  found  her  better;  headache  lessened;  pulse  100;  cough  loose; 
expectorates  freely;  she  sweat  freely  after  three  powders.  Continue  the 
same  treatment. 

"  13th.  Pulse  80;  skin  soft;  slept  well  last  night;  feels  very  well,  but 
weak;  cough  loose." 

Such  cases  constitute  a  large  number  of  those  which  occur;  and  yield  rea- 
dily to  small  doses  of  calomel  combined  with  opiates  and  warm  stimulating 
infusions.  In  some  of  the  cases  there  are  no  other  symptoms  than  debihty 
and  wandering  pains  in  the  back,  loins,  shoulders  or  legs.  Occasionally  an 
acute  pain  in  the  back  part  of  the  eye,  in  the  ears,  or  side  of  the  neck,  with 
stiffness  of  the  muscles,  is  present.  In  severe  cases  the  tonsils,  submaxillary 
and  sublingual  glands  are  swollen,  with  acute  pain  in  swallowing,  and  these 
are  usually  the  worst  cases.  Where  pneumonia  becomes  developed,  the 
calomel  and  opiates  are  continued  every  third  hour  for  36  or  48  hours,  aided 
by  the  warm  infusion  of  serpentaria  and  laxatives,  with  blisters  to  the  chest; 
usually  the  symptoms  yield  in  this  time,  although  sometimes  they  run  on 
for  six  or  seven  days; — this,  however,  is  not  often  the  case,  unless  deple- 
tion be  practised.  The  hot  skin  and  fever  with  bloody  expectoration  fre- 
quently induce  the  practitioner  to  draw  blood;  but  it  is  usually  thin  and 
watery,  having  more  the  appearance  of  coloured  serum  than  blood,  and 
having  no  adhesiveness.  The  pulse,  though  frequent  and  full  in  these  cases, 
feels  more  as  if  filled  with  air  than  fluid,  and  is  easily  compressed.  The 
blood  expectorated  is  dark-coloured,  and  the  expectoratioYi  viscid  and  tena- 
cious; it  is  oflen  of  a  bilious-looking  fluid,  which  is  a  favourable  indication. 

Frequently  the  pulmonary  symptoms  yield  suddenly,  and  a  metastasis 
occurs;  and  this  is  another  argument  in  favour  of  my  opinion  that  this 
disease  consists  in  irritation  and  irritability,  affecting  the  nervous  system  con- 
tinuously with  its  existence. 

I  remember  one  case  in  which  the  pulmonary  irritation  was  very  great  for 
two  days,  with  much  pain  and  difficulty  of  breathing;  suddenly  a  most  in- 
tense pain  attacked  the  peritoneal  covering  of  the  liver,  and  the  cough  and 
pain  in  the  chest  ceased.  Five  grs.  of  calomel  twice  repeated,  followed  by 
oil,  gave  relief,  and  no  farther  difficulty  occurred — the  girl  convalesced  di- 
rectly. 

Where  metastasis  occurs  to  the  bowels,  and  hemorrhage  results,  the  dis- 
charge is  critical;  when  to  the  peritoneum  it  is  usually  fatal;  when  to  the 
brain  it  almost  invariably  terminates  in  effusion.  If  much  depletion  is  used 
in  the  treatment,  the  liability  to  metastasis  is  much  increased,  especially  to 
the  brain. 

The  cases  require  to  be  carefully  watched  as  they  vary  much  in  their 
course,  although  the  primary  symptoms  are  similar,  and  usually  yield  to  the 
general  treatment. 


1842.]  Gibbes  on  Typhoid  Pneumonia,  295 

:  On  two  occasions,  where  the  pulmonary  symptoms  subsided  and  metasta- 
sis to  the  brain  took  place,  with  great  congestion,  I  opened  the  temporal 
arteries,  with  temporary  relief,  but  death  by  effusion  followed  in  both.  In 
these  cases  there  was  no  filling  out  of  the  pulse — it  became  smaller  and  more 
rapid,  with  delirium  before  death;  in  one  of  them,  (a  girl  of  13,)  screams  of 
intense  agony  followed  the  removal  of  the  blood,  and  death  within  a  few 
minutes. 

I  do  not  think  the  distinction  is  sufficiently  noticed  between  congestion 
and  inflammation;  in  the  former  condition  the  distension  of  the  vei7is  with 
symptoms  of  diminished  sensibility  in  the  nervous  energy  of  the  organ  is 
the  predominant  symptom;  in  the  latter  increased  arterial  action  with  in- 
creased sensibility  is  apparent.  If  the  venous  congestion  is  but  temporary 
and  the  nervous  energy  not  much  depressed,  active  inflammation  occurs 
when  by  reaction  an  effort  is  made  by  the  arteries  to  repair  the  effects  of  the 
temporary  delay  of  the  circulation  in  the  veins.  If  the  nervous  energy  is 
free  and  cumulative,  strong  inflammation  is  the  result.  If  congestion  from 
a  debilitating  cause  has  occurred,  and  has  remained  long  enough  to  oppress 
still  more  the  vital  energy  of  the  affected  organ,  the  weakened  power  of  the 
arteries,  when  they  receive  the  transfer  of  the  load  which  reaction  throws 
off  from  the  veins,  is  such  as  to  induce  only  a  subacute  inflammation  in  the 
organ.  This  state  is  removable  by  diffusion,  diaphoresis  and  revulsion,  at 
the  same  time  that  the  nervous  energy  is  restored,  so  as  to  prevent  again  the 
recurrence  of  the  congestion,  which  would  arise  from  its  deficiency. 

With  the  aid  of  nervous  power  the  arterial  system  repairs  most  of  the 
injuries  to  the  organs;  if  that  is  strong,  too  much  action  is  usually  developed 
by  the  arteries  in  this  function;  if  they  have  but  little  aid  from  it,  their  effort 
soon  ceases,  and  they  become  rapidly  exhausted,  and  effusion  results.  A 
proper  balance  can  only  be  restored  to  the  circulation  by  the  regular  renewal 
of  the  accustomed  supply  of  nervous  power. 

That  this  disease  may  and  does  assume  a  different  form  requiring  different 
treatment  in  other  localities  I  would  not  presume  to  deny;  but  here,  where  I 
have  been  familiar  with  it  for  a  long  time,  and  had  extensive  opportunities 
of  studying  its  phenomena,  I  am  satisfied  that  facts  will  bear  me  out  in  my 
opinion  of  its  character.  The  type  of  the  disease,  is  that  of  adynamia,  but 
with  a  debilitated  nervous  system;  local  inflammation  of  a  subacute  character 
arises  in  congested  organs,  and  it  is  all  important  to  remove  the  latter  con- 
dition by  such  means  as  will  not  only  not  reduce  the  former,  but  support  it. 

The  symptoms  in  the  attack  are  often  such  as  would  indicate  depletion  as 
necessary' — such  as  pain  in  the  head,  giddiness,  lethargy,  <fec.;  but, 

*'  Vascular  energy  is  wholly  derived  from  the  nervous  system.  If  by  any 
means  the  nerves  destined  to  supply  any  vessel  or  set  of  vessels  with  this 
energy  become  debilitated  or  destroyed,  then  these  vessels  cease  to  be  capa- 
ble of  duly  performing  the  function  of  propelling  the  fluids  to  and  from  the 
heart;  and  therefore  it  inevitably  follows  that  turgescence,  more  or  less  severe, 


296  Gibbes  on  Typhoid  Pneumonia.  [Oct. 

takes  place,  and  results  in  disease,  depending  on  the  organ  affected  for  its 
particular  character.  Thus  a  sudden  temporary  suspension  of  nervous  energy 
in  the  vessels  of  the  brain,  rendering  them  for  the  moment  incapable  of  pro- 
pelling forward  the  blood,  may  occasion  giddiness,  dimness,  or  distortion  of 
vision,  &c.;  and  if  these  symptoms  are  neglected,  this  temporary,  becomes  a 
lasting  loss  of  energy,  producing  either  immediate  death  or  a  total  suspen- 
sion of  vital  power  in  the  parts  dependent  upon  the  debilitated  nerves." 

The  symptoms  of  debility,  and  especially  the  cold  skin,  point  out  to  us 
the  necessity  of  stimuli  being  required,  and  the  very  doubtful  success  of 
bleeding  in  the  cold  stage  of  intermittents,  and  the  extreme  debility  conse- 
quent thereon,  should  remind  practitioners  that  these  symptoms  may  arise 
from  a  very  opposite  state  of  the  system  than  one  calling  for  depletion.  I 
believe  the  pain  in  the  head  in  this  affection  is  neuralgic.  I  have  seen  it  re- 
lieved in  a  few  hours  by  laudanum  or  camphor  and  opium;  I  have  often 
given  quinine  and  whiskey  with  advantage  to  it.  The  quick  soft  pulse  is  a 
pulse  of  irritation,  indicative  of  an  irritable  condition  of  the  nervous  system, 
and  not  an  index  of  the  amount  of  subacute  inflammation  in  the  lungs.  The 
condition  of  the  pulse  alone  will  frequently  mislead  the  practitioner  if  he 
depends  on  it  as  a  guide  in  diagnosis,  and  medical  men  differ  very  materially 
in  opinion  as  to  its  character. 

The  case  which  the  venerable  Dr.  Pairish  was  accustomed  to  relate  as 
having  occurred  while  Dr.  Wistar  was  in  Edinburgh,  here  presents  itself  to 
me. 

A  dog  was  bled  to  death  by  him  and  other  students.  Just  before  he  ex- 
pired an  eminent  practitioner  stepped  in;  not  being  aware  of  what  experi- 
ments were  in  progress,  he  was  asked  to  place  his  hand  on  the  dog's  heart, 
and  say  whether  the  action  was  sthenic  or  asthenic.  He  did  so,  and  declared 
the  excitement  sthenic. 

I  have  often  noticed  at  the  close  of  fatal  diseases,  especially  in  nervous 
constitutions,  the  action  of  the  heart  and  carotids,  and  been  struck  with  their 
apparently  sthenic  action  for  hours  when  debility  had  been  gradually  increas- 
ing from  steadily  failing  nervous  power,  and  the  system  becoming  progress- 
ively exhausted.  In  the  disease  of  which  I  am  treating,  I  have  never 
known  in  a  single  instance  the  pulse  to  rise  and  fill  out  after  venesection, 
or  become  slower,  which  should  be  the  case  if  the  frequency  depended 
on  inflammatory  congestion.  Often  have  I  known  it  become  smaller  and 
more  rapid;  and  I  now  never  think  of  bleeding  a  negro  in  this  disease. 
Where  the  pain  is  pleuritic,  and  the  cough  dry,  which  is  sometimes  the  case, 
dry  cups  to  the  chest  and  free  vesication  usually  give  relief,  with  the  full  and 
free  use  of  opiates.  As  I  mentioned  above,  negroes  bear  opiates  much  better 
than  whites,  and  suffer  but  seldom  from  any  bad  effects.  Dr.  Mott,  who  has 
had  much  experience  in  disease,  says: 

"  There  is  nothing  more  important  in  the  walks  of  medicine  and  surgery 
than  for  the  practitioner  to  make  a  distinction  between  these  two  opposite 


1842.]  Mettauer  on  the  Persimmon,  297 

states  of  the  system,"  (irritation  and  inflammation),  "and  if  great  opportu- 
nities of  observation  in  various  countries  could  authorize  me  to  pronounce 
an  opinion,  there  is  no  fact  more  incontestably  established  than  that  the  most 
fatal  results  in  the  practice  of  our  profession,  are  to  be  imputed  to  a  total 
misconception  of  these  lines  of  demarcation." — Travels,  p.  41. 

In  the  preceding  paper,  my  object  being  to  give  a  practical  article  and  to 
lead  the  profession  to  the  notice  of  this  disease,  I  have  made  no  references  to 
previous  accounts  in  the  books  of  similar  epidemics  in  other  countries.  I 
diflerfrom  some  of  my  professional  brethren  in  my  view  of  the  treatment  of 
this  affection,  and  I  am  disposed  to  throw  out  my  opinions  for  their  consi- 
deration. I  have  kept  no  special  records  of  cases  except  the  few  reported, 
but  my  success  in  the  treatment  is  the  proof  that  the  practice  will  answer, 
whatever  value  may  attach  to  the  theory.  During  the  winter  of  1840-41, 
out  of  fully  two  hundred  cases  there  were  only  five  deaths.  I  hope  that  in 
a  future  article  I  may  be  able  to  give  you  more  accurate  statistics. 

Columbia,  S.  C.  June  20th,  1842. 


Art.  IV. — On  the  use  of  the  unripe  fruit  of  the  Diospyros  Virginiana,  as 
a  Therapeiitic  Agent.     By  John  P.  Mettauer,  M.  D.,  of  Virginia. 

The  unripe  fruit  of  the  persimmon,  so  well  known  to  every  school-boy 
in  the  more  temperate  sections  of  the  United  States  for  its  intense  roughness, 
has,  most  remarkably,  hitherto  escaped  the  attention  of  practitioners  of  medi- 
cine as  a  therapeutic  agent.  If  it  has  been  noticed  at  all,  the  references  are 
so  brief  and  imperfect  as  to  furnish  nothing  likely  to  be  useful  in  a  practical 
point  of  view. 

Some  years  since  our  attention  was  directed  to  this  article  as  a  therapeutic 
agent,  while  treating  several  bad  cases  of  cholera  infantum  in  their  remote 
stages.  Well  recollecting  the  peculiar  rough  taste  imparted  to  the  tongue 
by  the  green  persimmon,  from  attempts  to  eat  the  fruit  in  our  boyhood,  it 
occurred  to  us  that,  as  all  other  astringents  which  had  been  employed  had 
failed  thus  far  in  their  treatment,  we  would  make  trial  of  it,  rather  as  an 
experiment  in  these  cases,  as  they  seemed  to  demand  astringents.  Our  first 
trial  consisted  of  the  use  of  the  simple  infusion,  formed  by  pouring  a  teacup 
of  boiling  water  upon  half  a  dozen  of  the  half-grown  persimmons  slightly 
crushed.  As  soon  as  the  infusion  was  cool,  we  directed  a  tea-spoonful  of  it 
to  be  given  to  an  infant  rather  more  than  a  year  old,  sweetened  with  refined 
sugar,  every  second  hour,  until  the  watery  discharges  from  the  bowels  under 
which  it  was  rapidly  wasting  should  be  arrested,  or  the  infusion  be  found  to 
disagree.     This  experiment  was  most  satisfactory,  and  the  result  truly  gra- 


298  Mettauer  on  the  Persimmon,  [Oct. 

tifying.  The  persimmon  had  only  been  administered  twice  before  the  bow- 
els were  restrained;  and  after  the  third  dose  it  was  suspended,  until  an  alvine 
discharge  could  be  procured  by  an  enema.  After  this,  the  remedy  was  only 
administered  occasionally,  as  the  diarrhcea  threatened  to  recur,  alternating 
with  it  from  time  to  time  enemata,  or  mild  internal  aperients.  In  a  fortnight 
after  this  agent  was  first  administered,  the  child  was  able  to  run  about  the 
house,  and  very  soon  recovered  perfectly. 

Since  the  first  trial  with  this  new  remedy,  we  have  had  many  opportuni- 
ties for  using  it  in  similar  cases,  and  even  in  common  diarrhoea,  and  the 
results  have  uniformly  been  decidedly  favourable  and  salutary. 

After  various  experiments  and  trials  with  this  substance,  we  have  adopted 
four  standard  preparations  for  using  it;  that  is,  the  tea  or  infusion;  the  syrup; 
the  vinous  and  acetous  tinctures. 

The  infusion  is  a  very  active  and  efficient  form,  and  will  be  found  both 
agreeable  and  convenient  for  administration:  it  can  only  be  employed,  how- 
ever, during  the  season  which  affords  the  fruit,  and  for  this  reason  only,  it 
is  to  be  regarded,  perhaps,  as  the  least  unexceptionable  of  the  preparations 
of  this  article.  Nevertheless,  the  infusion  may  be  used  with  great  advantage 
during  the  summer  and  early  autumnal  months — which  period  of  the  year 
is  most  prolific  of  the  forms  of  diarrhcea  in  which  astringents  are  allowable. 
It  may  be  prepared  by  infusing  from  one  to  two  ounces  of  the  fresh  imma- 
ture fruit  slightly  crushed,  in  a  common  teacup  of  boiling  water;  and  of  the 
cool  infusion  sweetened  with  refined  sugar,  from  one  to  three  tea-spoonfuls 
may  be  given  to  infants  once  an  hour,  or  after  longer  intervals,  until  the 
restraining  eff'ect  is  produced.  Occasionally  the  tea  may  be  rendered  aro- 
matic by  adding  cassia  bark,  pimento,  ginger  and  the  like;  or  it  may  be  ani- 
mated with  French  brandy,  gin,  or  wine  to  render  it  more  palatable.  When 
to  be  used  with  adults  the  doses  must  be  augmented  to  from  one  to  three 
table-spoonfuls;  and  given  after  the  intervals  already  stated. 

The  syrup  may  be  prepared  by  converting  the  infusion  already  described 
into  a  syrup,  by  adding  to  it  refined  sugar,  and  gently  boiling  them  down  to 
a  proper  consistency  for  keeping.  This  is  decidedly  the  most  convenient 
and  useful  form  of  using  the  persimmon;  it  is  also  the  most  agreeable,  as  the 
sugar  greatly  modifies  the  rough  taste.  This  syrup  may  be  variously  com- 
bined for  administration,  and  is  ready  and  at  home  at  all  seasons  of  the  year. 
It  also  possesses  the  astringency  of  the  persimmon  in  great  purity,  and  will 
retain  it  for  an  indefinite  period  of  time  without  the  least  deterioration. 

In  preparing  the  syrup,  care  should  be  taken  not  to  urge  the  process  of 
converting  the  infusion  into  a  syrup  too  rapidly;  gentle  and  gradual  boiling 
answers  best:  indeed,  the  fluid  should  just  be  kept  to  the  boiling  point;  and 
the  process  must  be  conducted  over  a  sand  bath,  or  a  salt-water  bath;  and 
glass  vessels  should  invariably  be  used  for  the  purpose. 

For  infants,  the  doses  of  the  syrup  may   be  very   nearly   as  we  have 


1842.]  Mettauer  on  the  Persimmon.  299 

advised  of  the  infusion;  perhaps  they  should  be  somewhat  smaller.  With 
adults  we  have  invariably  used  from  two  to  four  tea-spoonfuls  to  the  dose. 

The  vinous  tincture  may  be  prepared  by  digesting  one  pound  of  the  green 
persimmon  recently  procured  and  a  little  crushed,  in  one  pint  and  a  half  of 
port,  or  any  other  wine,  exposed  daily  to  the  solar  heat  for  fourteen  days. 
After  this  the  tincture  may  be  filtered  for  use.  This  is  an  elegant  prepara- 
tion, and  possesses  the  astringent  powers  of  the  persimmon  in  great  purity, 
and  in  a  most  convenient  form  for  administration.  It  is  not,  however,  appli- 
cable to  every  variety  of  diarrhoea,  by  reason  of  the  stimulating  menstruum 
used  in  its  preparation.  This  preparation  is  more  especially  applicable  to 
the  treatment  of  adult  cases  of  diarrhoea,  though  we  have  occasionally  em- 
ployed it  with  infants  likewise.  The  dose  for  adults  is  very  nearly  the 
same  as  advised  of  the  syrup.  With  infants  the  dose  should  rarely  exceed 
a  tea-spoonful,  and  must  invariably  be  small  to  commence  with,  say  not 
more  than  one-third  of  a  tea-spoonful;  and  the  medicine  should  always  be 
sweetened  with  refined  sugar. 

The  acetous  tincture  is  prepared  by  digesting  two  pounds  of  the  recent 
fruit  a  little  crushed,  in  two  pints  of  strong  pure  apple-vinegar,  fourteen  days 
exposed  to  the  solar  heat;  the  tincture  may  then  be  filtered  for  use.  This 
preparation  is  chiefly  designed  for  external  use,  especially  for  gargles  and 
cataplasms.  It  is  most  valuable  in  tonsillary  affections,  especially  when 
they  follow  scarlatina,  or  chronic  catarrh,  used  as  a  gargle.  It  is  also  ex- 
ceedingly useful  as  a  cataplasm  in  whitlow,  or  inflammations  of  the  mammae 
threatening  milk  abscess.  To  form  it  into  a  cataplasm,  it  will  only  be  neces- 
sary to  convert  any  quantity  of  the  tincture  into  a  poultice,  by  uniting  with 
it  when  hot,  the  requisite  proportions  of  any  kind  of  farinaceous  material; 
even  the  fruit  may  be  used.  We  have  also  employed  it  in  the  early  stages 
of  dysentery  after  a  brisk  cathartic,  and  with  decidedly  beneficial  effects:  in 
this  disease  it  promises  to  be  eminently  useful.  It  is  a  more  efficient  remedy 
in  this  disease  than  the  solution  of  common  salt  in  vinegar,  to  which  how- 
ever, it  assimilates  itself  very  much  in  its  remedial  action. 

The  astringency  of  the  persimmon  is  peculiarly  adapted  to  the  treatment 
of  every  form  of  diarrhoea.  In  the  diarrhoea  of  infancy,  we  have  often  used 
the  infusion  and  syrup  with  distinguished  benefit.  The  tinctures  we  have  also 
occasionally  employed,  but  not  with  very  decided  benefit  with  these  tender 
subjects,  chiefly,  we  think,  because  we  were  unwilling  to  hazard  their  use 
with  them  in  commanding  doses.  We  have  frequently  united  the  infusion  and 
syrup,  with  the  syrups  of  rhubarb  and  senna,  or  the  infusion  of  senna;  and 
occasionally  with  calomel,  with  benefit.  With  stimulants  and  tonics  these 
preparations  may  also  often  be  associated  with  advantage.  In  some  exceed- 
ingly bad  cases  of  protracted  Mississippi  diarrhoea,  we  have  used  the  per- 
simmon with  the  most  triumphant  and  salutary  effects.  In  these  cases  we 
generally  premise  one  or  two  doses  of  blue  mercurial  powder,  about  twelve 
grains,  before  commencing  with  the  persimmon;  and  the  infusion,  syrup,  or 


300  Shanks  on  Sore  Mouth  of  Nursing  Women,  [Oct. 

vinous  tincture  given  in  port  wine,  one  of  the  forms  of  using  it  generally 
adopted  by  us.  Should  the  remedy  restrain  the  bowels  very  suddenly, 
aperients  must  be  interposed;  and  for  this  purpose,  nothing  answers  so  well 
as  the  syrup  of  rhubarb,  or  the  compound  syrup  of  senna. 

Occasionally,  we  have  found  it  useful  to  combine  grain  portions  of  ipeca- 
cuanha with  the  persimmon,  with  a  view  to  its  diaphoretic  effects:  with 
adults,  especially,  it  will  be  found  exceedingly  beneficial  to  use  such  a  com- 
bination. 

In  the  chronic  stage  of  dysentery,  we  have  employed  these  forms  of  the 
persimmon  very  beneficially.  When  used  in  this  disease,  they  must  be 
united  with  the  syrup  of  rhubarb,  or  senna;  or,  combined  with  the  oleagi- 
nous emulsion;  and  generally,  paregoric  in  sufficient  doses  to  impress  the 
system  decidedly,  should  be  given  with  them  at  night. 

In  uterine  hemorrhage,  and  especially  in  menorrhagia,  we  have  employed 
the  infusion,  both  as  an  internal  remedy,  and  by  way  of  injection,  per  vagi- 
nam,  with  great  benefit.  In  these  fluxes  it  is  destined  to  be  eminently  useful 
from  the  promptness  and  great  potency  of  its  action  as  an  astringent;  much, 
however,  remains  to  be  known  of  the  remedial  operation  and  applicability 
of  the  persimmon  as  a  therapeutic  agent. 

Prince  Edward  Court  House,  Va.,  May  28th,  1842. 


Art.  V. — On  Endemic  Sore  Mouth  and  Diarrhoea  peculiar  to  Nursing 
Women.     By  Lewis  Shanks,  M.  D.,  of  Memphis,  Tennessee. 

Since  my  attention  was  called  by  you,  (while  in  Philadelphia,  in  April 
1841,)  to  a  communication  from  Dr.  Backus,  of  Rochester,  New  York, 
published  in  the  previous  January  number  of  your  Journal,  "  On  a  form  of 
sore  mouth  peculiar  to  nursing  women,"  I  have,  in  addition  to  my  own 
observations,  conversed  with  the  oldest  practising  physicians  of  this  city  and 
neighbourhood,  to  enable  me  to  give  the  characteristic  symptoms  of  that 
peculiar  disease,  as  they  present  themselves  in  this  region  of  country. 

This  communication  has  been  delayed  for  the  purpose  of  observing  more 
closely  the  symptoms  that  mark  the  diflJerent  stages  of  the  disease,  but  its 
prevalence  and  severity  have  so  much  abated  here,  that  the  last  year  has 
furnished  the  closest  observer  with  little  additional  information. 

As  the  standard  works  contain  no  description  of  the  disease,  and  the 
account  of  it  and  its  treatment,  given  by  Dr.  Backus,  the  only  one  I  have 
seen,*  materially  differs  from  the  general  symptoms,  and  the  proper  treat- 

[*  An  account  of  the  affection  as  it  occurs  in  Boston  was  given  in  our  No.  for  April 
last,  p.  510,  et  se^.— Ed.] 


1842.]  Shanks  on  Sore  Mouth  of  Nursing  Women.  301 

ment  of  the  disease  as  it  prevails  here,  it  is  important  that  a  somewhat 
extended  account  of  the  symptoms,  treatment  and  probable  cause  of  the  dis- 
ease should  be  given,  that  the  attention  of  the  profession  may  be  called  to  it 
in  those  localities  where  it  prevails,  that  its  pathology  and  treatment  may  be 
satisfactorily  understood. 

Symptoms. — In  most  of  the  cases  in  which  this  form  of  sore  mouth 
occurs  after  confinement,  the  last  months  of  gestation  are  attended  with 
functional  deragement  of  the  liver,  stomach  and  bowels,  evinced  by  acidity, 
flatulence,  white  viscid  secretions,  producing  vomiting,  which  instead  of 
occurring  in  the  morning  as  in  the  early  months  of  pregnancy,  mostly  takes 
place  soon  after  lying  down  at  night.  These  symptoms,  when  distressing, 
are  attended  with  an  irregular,  often  morbidly  craving  appetite,  and  consti- 
pated bowels. 

If  not  soon  relieved,  the  tongue,  though  clean,  becomes  red,  the  papilla 
flaccid  and  projecting,  giving  it  a  peculiar  rough  and  raw  appearance,  with 
diffused  redness  and  tenderness  of  all  the  inside  of  the  mouth  and  throat. 
The  secretion  from  the  mouth  is  acrid,  producing  a  burning  or  scalding 
sensation. 

This  appearance  of  the  mouth  occurs  during  gestation  in  the  plethoric  and 
more  vigorous,  and  is  always  attended  with  feverish  excitement.  In  the 
more  feeble  and  phlegmatic,  the  functional  derangement  is  unaccompanied 
with  fever,  and  the  tongue  and  mouth,  though  tender  and  sometimes  sore, 
are  pink-coloured,  flaccid  and  smooth. 

If  the  morbid  secretions  produce  diarrhoea,  an  immediate  improvement  in 
the  condition  of  the  mouth  ensues.  When  constipation  occurs  again,  the 
sore  mouth  returns  in  a  more  distressing  degree.  So  the  latter  months  of 
gestfition  go  on — with  constipation  and  sore  mouth,  alternating  in  some 
cases  with  diarrhoea  and  ameliorations  of  the  disordered  stomach  and  sore 
mouth. 

In  these  cases,  where  the  tendency  to  the  chronic  form  of  this  disease 
during  lactation,  is  indicated  by  the  above  symptoms  in  the  latter  months  of 
gestation,  the  abstinence  generally  enjoined  after  confinement  produces  alle- 
viation, and  sometimes  almost  entire  exemption  from  the  disease  for  a  time. 
In  a  few  weeks,  however,  the  symptoms  of  disordered  stomach  and  sore 
mouth  are  again  manifested  by  disordered  secretions,  and  in  every  case  dur- 
ing nursing,  attended  with  more  or  less  profuse  diarrhosa.  The  diarrhoea  is 
not  attended  with  much,  if  any  pain.  The  discharges  are  free  and  copious 
— thin  and  dirt-coloured,  or  in  the  more  protracted  and  severe  forms,  ash- 
coloured,  or  light,  fermented,  and  frothy.  The  diarrhoea  occasionally 
alternates  with  a  few  days  of  constipation,  when  the  sore  mouth  be- 
comes more  distressing  from  an  increase  of  the  rawness  and  scalding  secre- 
tion. 

The  appetite  is  irregular,  digestion  imperfect,  acidity  and  flatulence,  with 
occasional  distension  of  the  stomach. 

No.  VIII.— October,  1842.      .  26 


302  Shanks  on  Sore  Mouth  of  Nursing  Women.  [Oct. 

The  strength  fails  in  proportion  to  the  violence  of  the  disease,  and  the 
natural  vigour  of  constitution.  The  pulse  becomes  frequent  and  feeble. 
The  skin  relaxed  with  a  tendency  to  profuse  perspiration  from  exercise, 
and  during  sleep. 

From  the  commencement  to  the  termination  of  the  disease,  the  most  dis- 
tressing symptom  is  the  sore  mouth,  which  keeps  the  sufferer  in  constant 
agony  either  from  a  continued  scalding  or  burning  sensation,  or  so  great  a 
degree  of  tenderness,  that  the  blandest  food,  or  the  friction  from  conversation 
produces  pain. 

The  clean,  red  and  raw  appearance  of  the  tongue  and  mouth,  described  as 
occurring  temporarily  in  the  last  months  of  gestation,  often  presents  itself  in 
the  first  stage  of  the  disease  during  nursing,  attended  with  acrid  secretion, 
but  after  the  case  becomes  chronic,  the  most  common  condition  of  the  tongue 
and  mouth  is  clean,  smooth,  slick,  pink-coloured  and  exceedingly  sensitive 
— the  lining  membrane  seeming  too  thin  to  protect  the  sensitive  nervous 
expansion  from  irritation;  and  after  long  continuance,  ulceration  sometimes 
takes  place  under  the  tongue,  and  on  the  inside  of  the  mouth. 

So  long  as  the  condition  of  the  mouth  and  stomach  allows  the  system  to 
be  supplied  with  nourishment  sufficient,  the  secretion  of  milk  is  abundant, 
and  the  child  continues  thrifty  and  well.  Indeed,  in  many  cases  when  the 
appetite,  or  ability  to  eat,  and  the  digestion  are  so  impaired,  and  the  diar- 
rhoea so  profuse  as  to  render  the  mother  scarcely  able  to  rise  from  her  bed, 
the  child  continues  in  perfect  health. 

This  disease,  running  through  its  stages,  as  described,  presents  the  pre- 
monitory symptoms  before  confinement,  and  usually  commences  soon  after- 
wards. Cases  sometimes  occur,  however,  in  which  no  distinctive  symptoms 
indicate  the  onset  of  the  disease  until  from  the  second  to  the  fifth  month  of 
lactation.  These  cases  exhibit  all  the  characteristic  symptoms,  and  often 
as  much  severity  as  those  preceded  by  the  premonitory  symptoms  before 
confinement,  and  occurring  earlier  after  it. 

If  not  relieved,  it  produces  more  or  less  speedily  great  emaciation,  debi- 
lity and  nervous  irritation  of  the  system,  resulting  sooner  or  later  in  death. 

Treatment. — The  functional  derangement  of  the  liver  and  stomach,  and 
less  severe  degree  of  sore  mouth  which  occurs  in  the  last  month  of  gesta- 
tion, and  which  are  indicative  of  the  more  severe  and  chronic  form  of  the 
disease  during  nursing,  may  be  much  relieved  by  medicine  and  dieting,  and 
the  severity  of  the  symptoms  during  lactation  thereby  be  much  abated.  In 
the  more  robust  and  plethoric,  the  feverish  excitement  must  be  relieved  by 
bleeding,  which  should  be  followed  by  alteratives  and  laxatives,  such  as 
blue  mass,  cal.  magnesia  and  rhubarb,  &c.,  in  small  doses.  Diet  plain  and 
digestible. 

In  those  of  more  feeble  health,  in  whom  little  or  no  feverish  excitement 
exists,  a  combination  of  blue  mass,  ipecac,  carb.  of  iron,  rhubarb  and  aloes, 
in  such  proportions  as  suit  the  particular  case,  answers  well  as  an  alterative 


1842.]  Shanks  on  Sore  Mouth  of  Nursing  Women,  .  303 

and  tonic  laxative.     Ipecac,  alone,  in  doses  of  from  one  half  to  two  grains, 
is  a  good  remedy. 

During  nursing,  when  the  disease  becomes  chronic,  and  the  sore  mouth 
is  attended  with  diarrhoBa,  emaciation,  &c.;  the  stage  when  the  physician  is 
often  first  consulted,  a  regular  course  of  alteratives,  together  with  the  most 
rigid  attention  to  diet  is  indispensable  to  effect  a  cure. 

In  some  bad  cases  a  combination  of  arsenic  and  corrosive  sublimate,  each 
a  sixteenth  of  a  grain  in  sokition  two  or  three  times  a  day,  with  diet  and 
drink,  consisting  of  soda  with  barley  water,  lime  water  and  milk,  have  suc- 
ceeded with  me  better  than  any  other  course. 

When  the  diarrhcea  is  relieved,  and  the  mouth  becomes  less  sensitive,  the 
diet  to  be  made  more  nourishing  by  the  addition  of  rice,  barley,  arrowroot, 
or  stale  bread  and  boiled  milk.  Dr.  Christian,  the  oldest  practitioner  in  this 
city,  relies  mainly  on  ipecac,  in  doses  of  from  a  half  to  two  grains  repeated 
three  or  four  times  a  day  as  an  alterative.  Others  prefer  blue  mass,  carb.  of 
iron,  rhubarb,  and  sometimes  opium  combined  with  the  ipecac,  or  blue 
mass  and  soda  with  the  drink.    Active  purgatives  of  all  kinds  are  injurious. 

As  a  wash  for  the  mouth,  the  infusion  of  bloodroot  (sanguinaria  Cana- 
densis) is  perhaps  the  best.  Other  astringent  washes  are  sometimes  useful 
as  palliatives,  especially  with  the  addition  of  burnt  alum  or  borax.  In  bad 
cases,  however,  when  there  is  much  debility,  emaciation,  and  nervous  irri- 
tation of  the  system,  the  experience  of  all  the  physicians  in  this  region  of 
country  concurs  in  the  indispensable  necessity  of  weaning  the  child  to  cure 
the  disease,  and  in  some  cases  to  save  the  life  of  the  patient.  The  improve- 
ment from  an  alarming  state  of  debility  and  emaciation  after  weaning  the 
child  is  often  prompt  and  rapid. 

This  well  demonstrated  fact  presents  a  remarkable,  and  perhaps  inexpli- 
cable peculiarity  attending  this  disease — that  the  child  must  be  deprived  of 
its  natural  sustenance,  and  a  free  and  healthy  secretion  from  the  breasts 
must  be  arrested  by  weaning,  to  correct  the  morbid  secretions  of  the  liver 
and  the  whole  alimentary  canal,  and  save  the  life  of  the  mother. 

Causes. — The  predisposing  cause  of  this  disease  seems  to  be  marsh 
miasm,  combined  with  humidity  of  the  atmosphere,  as  the  disease  never 
prevails  in  high  dry  regions  of  country,  free  from  humidity  of  atmosphere, 
and  marsh  miasm.  In  further  confirmation  of  this  opinion,  deranged  secre- 
tion of  the  liver  and  stomach  are  found  invariably  to  precede  and  attend  the 
disease.  In  the  first  settlement  of  this  town  and  country,  intermittent  fever 
was  very  common.  As  the  country  has  been  cleared,  improved,  and  made 
dryer,  and  consequently,  the  humidity  of  miasmata  in  the  atmosphere  dimi- 
nished, the  endemic  fevers  of  the  country  have  become  less  prevalent,  and 
this  endemic  sore  mouth  has  diminished  in  its  prevalence  and  severity  in 
like  proportion.  Formerly,  at  all  seasons  of  the  year,  few  women  escaped 
it  in  some  degree  during  lactation;  now,  since  the  country  has  become  more 
exempt  from  intermittents,  this  affection  has  become  more  rare — attacking 


304  Shanks  on  Sore  Mouth  of  Nursing  Women.  [Oct. 

mainly  those  who  are  unacclimated,  or  of  feeble  health,  of  leucophlegmatic 
temperament,  or  of  previous  predisposition  from  functional  derangement  of 
the  liver  and  stomach,  while  the  acclimated,  healthy,  and  robust  resist  this 
atmospheric  influence,  and  are  able  to  nurse  their  children  with  impunity. 

That  the  predisposition  is  thus  produced,  is  farther  evinced  by  the  fact 
that  chronic  diarrhosa,  in  humid  miasmatic  localities  in  males,  presents  many 
of  the  general  symptoms  of  this  disease  peculiar  to  nursing  females.  In  this 
city  and  country,  cases  of  diarrhoea  of  a  protracted  and  chronic  character 
present  themselves  especially  in  persons  of  intemperate  habits,  accompanied 
with  sore  mouth,  and  a  peculiar,  clean,  red  and  raw  tongue,  with  ulceration 
of  its  under  side  and  the  inside  of  the  mouth.  These  cases  are  always  pro- 
duced by  and  accompanied  with  morbid  secretion  of  the  liver  and  sto- 
mach; but  are  different  from  the  afiection  in  females  in  the  characteristic 
symptoms. 

Believing  the  disease  to  result  from  marsh  miasm,  induced  me  to  use  the 
corrosive  sublimate  and  arsenic  as  an  alterative,  and  the  superior  effect  of 
that  combination  over  mercurials  alone  is  another  proof  of  the  cause  of  the 
disease. 

From  the  highly  satisfactory  alterative  effect  of  iodide  of  mercury  in  other 
cases  of  functional  disease  of  the  stomach  and  liver,  in  relaxed  feeble  habits, 
I  have  no  doubt  of  its  peculiar  adaptation  to  the  cure  of  this  disease,  and 
mean  to  embrace  the  first  opportunity  to  try  it. 

In  the  description  of  this  disease  as  it  prevails  at  Rochester,  given  by  Dr. 
Backus,  the  onset  is  often  sudden,  and  the  bowels  always  constipated;  and 
the  most  successful  treatment  consists  in  the  use  of  alteratives  combined 
"with  laxatives.  Here  it  comes  on  gradually,  and  in  its  well-marked  chronic 
form,  which  never  occurs  except  during  lactation,  the  constant  diarrhoea 
precludes  the  use  of  purgatives  or  laxatives. 

Were  it  likely  to  be  useful,  we  might  argue  to  prove,  that  in  this  latitude, 
the  long-continued  heat  of  the  summers,  the  mildness  and  dampness  of  the 
winters,  produce  a  want  of  tone  in  the  system,  and  relaxation  especially  of 
the  serous  and  mucous  membranes,  which  account  for  the  difference  in  the 
symptoms  in  the  disease  in  a  northern  and  southern  latitude,  while  the  local 
similitude  of  country  necessary  to  produce  humidity  and  miasmata  is  the  same. 

In  this  city,  and  in  the  level  alluvial  country,  constipation  of  the  bowels 
is  rare  either  in  health  or  disease.  Little  difficulty  is  generally  found  in 
opening  the  bowels,  and  much  less  of  any  purgative  is  required  than  in  a 
northern  latitude,  or  even  in  this  latitude  in  the  high  dry  country  east  of  the 
Mississippi  River.  But  we  have  already  extended  this  subject  more  than 
was  designed. 

Memphis,  July  ISth,  1842. 


1842.]  Norris  on  Deformities  after  Fractures.  305 


Art.  VI. — On  the  Treatment  of  Deformities,  following  unsuccessfully 
treated  Fractures.  By  George  W.  Norris,  M.  D.,  one  of  the  Surgeons 
to  the  Pennsylvania  Hospital. 

Irregularly  united  fractures  sometimes  fall  under  the  notice  of  the  sur- 
geon attended  with  so  much  shortening  or  deformity  as  to  render  the  limb 
unsightly,  painful,  or  altogether  useless,  and  although  the  sufferers  in  such 
cases  are  generally  eager  for  relief,  yet  the  general  practice  has  been,  at  least 
in  this  country  and  Great  Britain,  to  abstain  from  any  operative  measures 
for  the  remedying  of  such  states.  Operations,  hovi^ever,  have  been  often 
proposed  and  practised  for  the  removal  of  vicious  consolidations,  and  be- 
lieving them  to  be  frequently  remediable,  we  think  it  well  to  call  the  atten- 
tion of  the  profession  to  this  interesting  subject,  by  bringing  to  their  notice 
the  various  methods  by  which  it  may  be  done,  and  recalling  to  memory  the 
different  numerous  instances  in  which  they  have  succeeded. 

The  means  proposed  for  the  removal  of  deformities  following  fractures 
are  of  three  kinds.  The  first,  consists  in  straightening  a  crooked  limb  by 
means  of  well  applied  pressure;  the  second,  in  re-fracturing  the  bone  at  the 
point  of  former  injury  in  order  by  an  after  treatment  to  give  it  a  better  direc- 
tion; and  the  third,  in  making  a  section  of,  or  removing  the  projecting  or 
angular  portions  of  bone,  which  give  rise  to  the  deformity. 

1.  Pressure  and  extension  of  the  limb.  The  researches  of  Duhamel, 
Breschet,  Dupuytren,  and  others,  upon  the  formation  of  callus,  have  proved 
beyond  cavil  the  possibility  of  straightening  deformed  limbs  at  considerable 
intervals  after  the  occurrence  of  fractures,  by  means  of  pressure,  conjoined 
•with  extension  and  counter-extension.  This  method,  however,  is  aj^licable 
only  to  those  cases  in  which  the  callus  has  not  yet  acquired  all  the  solidity 
of  bone — an  event,  which,  in  the  majority  of  cases  does  not  occur  till  the 
fiftieth  or  sixtieth  day.  Dupuytren  furnishes  examples  of  limbs  straightened 
by  this  method  as  late  as  the  one  hundred  and  twentieth  day  after  the  re- 
ceipt of  the  injury,  and  fixes  upon  the  sixtieth  day  as  the  medium  time  at 
which  benefit  is  likely  to  be  derived  from  it.  In  bringing  about  straightening 
of  the  limb,  extension  and  counter-extension  is  to  be  employed  in  the  same 
manner  as  in  cases  of  recent  fracture,  the  limb  being  drawn  down  with  some 
force  every  second  or  third  day,  care  being  taken  at  tlie  same  time  to  keep, 
by  means  of  the  extending  apparatus,  what  is  gained  by  these  forcible  efforts. 

Sometimes,  however,  when  the  callus  is  very  yielding,  the  parts  may  be 
dragged  at  once  to  a  better  position,  and  so  retained,  though  generally  the 
contracted  state  of  the  muscles  accompanying  these  cases,  prevents  this 
being  done. 

Extension  and  pressure  made  with  the  aid  of  machinery,  have  also  been 
successfully  applied  to  the  remedying  of  these,  as  of  other  deformities,  and 

26* 


306  Norris  on  Deformities  after  Fractures.  .        [Oct. 

sometimes  with  marked  success.  An  instance  of  this  is  related  in  the  Trans- 
actions of  the  Medical  Society  of  Lyons,  by  M.  Desgranges.  The  case 
was  that  of  a  female,  who  being  badly  treated  in  a  chirurgical  point  of  view 
after  a  fracture  of  the  leg,  found  the  limb  at  the  end  of  four  months,  so 
crooked  that  she  was  obliged  to  walk  on  the  exterior  edge  of  the  foot.  M. 
D.  undertook  to  remedy  this  defect,  and  by  means  of  a  machine,  making 
well  applied  pressure  on  the  protuberant  angle  of  the  fracture,  obtained  per- 
fect rectitude  of  the  leg. 

2.  Rupture  of  the  Callus. — Among  the  ancients,  some  of  the  surgical 
writers  of  authority  recommended  and  practised  in  these  cases,  the  ruptur- 
ing of  newly  consolidated  bones,  while  others  strenuously  opposed  it.  In 
modern  times,  the  practice  was  revived  by  (Esterlen,  and  has  received  coun- 
tenance from  practitioners  of  eminence  on  the  continent  of  Europe;  Kiche- 
rand,  Dupuytren,  Velpeau,  and  many  others,  admitting  of  its  employment 
in  certain  extreme  cases.  Such  being  the  case,  it  will  be  well  to  examine 
its  claims  to  attention,  and  cast  a  retrospective  glance  at  the  judgments  passed 
upon  the  method  by  the  recognised  authorities  in  our  science,  as  well  for  the 
purpose  of  exposing  its  dangers,  as  of  learning  the  benefits  which  in  some 
cases  may  be  derived  from  it. 

The  earlier  of  the  ancient  writers  who  recommended  the  rupturing  of  the 
callus,  produced  it  by  means  of  blows  with  a  hammer  or  other  similar  means, 
the  member  being  previously  covered,  and  protected,  to  prevent  injury  to  the 
soft  parts,  and  when  done  in  this  manner,  we  can  well  conceive  that  it 
would  be  likely  to  be  followed  with  serious  consequences.  Rhazes,  who 
particularly  noticed  this  practice  among  the  surgeons  of  his  time,  boldly 
opposed  it,  urging  the  danger  of  fracturing  the  bone  elsewhere  than  at  the 
seat  of  previous  injury,  and  recommended  the  adoption  of  emollient  appli- 
cations, with  pressure  and  extension  in  lieu  of  it.  Haly  Abbas  speaks  of 
an  old  man  with  a  deformity  following  the  consolidation  of  a  fractured 
thigh,  who  died  from  the  effects  of  the  rupturing  operation. 

Guy  de  Chauliac,  in  cases  where  the  callus  was  not  older  than  six  months, 
recommends  to  break  the  bone  again  at  the  same  point  with  the  knee,  after 
having  used  emollient  and  relaxing  applications,  and  afterwards  treating  it  as 
a  recent  fracture. 

Ambrose  Pare  speaks  of  the  operation  only  to  condemn  it,  except  in  cases 
where  the  callus  is  still  soft,  and  the  extremity  so  much  deformed,  as  to  hin- 
der the  patient  from  using  it,  and  even  in  these  instances,  before  proceeding 
to  the  straightening  of  the  limb,  he  advises  the  softening  of  the  new  growth 
by  means  of  plasters  and  emollients,  for  fear  of  breaking  the  bone  at  some 
other  point  than  that  at  which  it  had  first  given  way. 

Fabricius  Hildanus  rejects  the  operation,  affirming  at  the  same  time  that 
neither  Hippocrates  nor  Galen  practised  it,  and  supports  his  opinion  against 
its  employment  by  the  experience  of  Pare,  lessen,  Guy  de  Chauliac,  Albu- 
casis  and  Avieenna,  all  of  whom  were  opposed  to  the  forcible  rupturing  of 
the  bones  after  firm  union. 


1842.]  Norris  on  Deformities  after  Fractures,  307 

Purmann*  recommends  relaxing  applications  when  the  arm  or  leg  present 
deformities  which  are  not  of  long  duration,  and  afterwards  extension  of  the 
member  by  means  of  certain  instruments,  as  the  glosso-comium.  But  if  the 
callus  had  already  attained  perfect  firmness,  after  the  use  of  the  same  topical 
applications,  he  advises  rupturing  of  the  bones  at  the  point  of  previous  frac- 
ture by  means  of  a  machine  worked  by  a  screw,  which  is  accurately  de- 
scribed by  him.  Passing  over  the  opinions  of  many  esteemed  writers, 
though  of  less  authority  on  the  particular  subject  of  which  we  are  treating 
than  those  we  have  just  quoted,  it  may  be  well  to  dwell  for  a  few  minutes 
on  those  of  some  of  the  authors  who  have  written  upon  the  subject  nearer 
to  our  own  times. 

Morgagnit  speaks  of  the  operation  of  rupturing  the  callus  and  straighten- 
ing the  limb,  as  having  to  his  knowledge  succeeded  in  some  cases,  but  at  the 
same  time  adds,  that  an  instance  was  known  to  him,  in  which  the  same  ope- 
ration upon  the  leg  was  followed  by  death.  Duverney,  who  in  an  especial 
manner  studied  the  injuries  to  which  the  bones  are  liable,  remarks,  that  de- 
formity after  fractures  "  has  determined  many  to  the  expedient  of  breaking 
the  thigh  anew,  in  order  to  remedy  it.  But  this  operation  has  been  unsuc- 
cessful, nay  on  the  contrary  even,  they  have  been  in  a  worse  state  than 
otherwise  they  would  have  been  in."     {Trans,  by  Ingham,  p.  137.) 

In  a  work  in  our  own  language  which  is  deserving  of  more  frequent  re- 
ference than  it  now  receives,  we  find  the  following. 

"  The  crooked  limb  left  after  a  fracture  is  very  common,  and  admit  the 
callus  has  been  a  month,  but  especially  of  a  longer  date,  I  see  little  likeli- 
hood of  remedy.  The  breaking  asunder  forcibly  the  new  cement  at  these 
times  has,  I  think,  but  rarely  answered.  Nor  are  we  sure,  after  this  second 
rupture,  of  success.  From  the  larger  bones,  as  of  the  leg,  but  particularly 
of  the  thigh,  thus  served  to  gratify  some  more  nice  than  prudent  people, 
X  have  known  abscesses  arise,  and  the  fracture,  before  simple,  now  made 
compound,  by  a  new  afilux  of  humours;  at  length  rigors  and  convulsions 
have  ensued,  and  carried  off* the  patient" — "others,  though  with  less  of  ha- 
zard to  their  lives,  I  have  known  fare  little  better  as  to  the  straightness  of  their 
limbs;  and  some,  after  the  pain  they  have  hereby  undergone,  have  been  left 
worse  than  before."  (Turner,  vol.  2,  p.  189,  90,  2d.  ed.  Lond.  1725.) 
Heister,!  however,  thinks  that  "  when  the  callus  is  tender,  and  the  patient 
young  and  vigorous,  the  operation  may  be  fairly  attempted,"  but  neverthe- 
less hints,  that  if  the  deformity  and  hindrance  from  the  fracture  are  but 
slight,  it  is  better  to  avoid  the  operation,  as  it  is  neither  free  from  pain  nor 
danger. 

To  rupture  the  callus,  OEsterlen  employed  a  complicated  machine  modified 
from  those  of  Purmann  and  Bosch,  the  principle  of  which  consists  in  hav- 

*  OEsterlen,  Sur  la  Rupture  du  Cal.  p.  18. 
t  Epist.  56,  p.  154;  vol.  9,  8vo.     Paris,  1824. 
t  System  of  Surgery,  p.  117.    London,  1743. 


308  Norris  on  Deformities  after  Fractures,  [Oct. 

ing  a  pad  attached  to  a  piece  of  plank  which  by  means  of  screws  is  made 
to  descend  gradually,  and  press  upon  the  convex  surface  of  the  callus,  the 
deformed  limb  having  been  previously  fixed  upon  another  padded  plank  to 
which  they  are  attached.  A  sketch  of  this  machine  is  figured  in  his  work, 
but  all  that  is  sufficient  where  this  process  is  adopted,  is,  to  fix  the  limb  to 
be  operated  on  upon  a  firm  mattrass  or  table,  while  at  the  same  time  pres- 
sure is  made  suddenly  and  firmly  by  means  of  the  hands,  or  knee,  of  the 
surgeon.  A  number  of  facts  collected  by  (Esterlen  from  the  older  writers, 
as  well  as  those  given  by  him  as  occurring  either  in  his  own  practice,  that  of 
Bosch,  or  of  other  surgeons  of  his  country,  clearly  show  that  the  fracture 
following  the  rupture  of  the  callus  is  generally  exempt  from  contusion,  or 
other  serious  complication,  and  that  it  may  be  cured  as  readily  as  an  ordinary 
simple  fracture.  Setting  aside,  however,  the  statement  of  the  acknowledged 
advocate  of  this  mode  of  practice,  facts  will  at  once  present  themselves  to 
the  mind  of  every  surgeon  to  show  the  facility  with  which  the  callus  of  bro- 
ken bones  may  be  fractured,  and  the  little  danger  attendant  upon  its'rupture, 
previous  to  the  deposite  of  that  substance  in  its  definitive  form,  that  is,  previous 
to  the  lapse  of  four  or  five  months,  as  well  as  to  prove  that  bones  recently 
consolidated  give  way  more  easily  at  the  first  point  of  injury,  than  else- 
where. These  facts  are  not  unfrequently  witnessed  by  patients  refracturing 
their  limbs  by  falls,  a  considerable  time  after  convalescence  from  previous 
like  injuries,  in  whom,  although  in  some  cases  produced  by  great  violence, 
and  accompanied  with  much  contusion,  we  find  consolidation  to  proceed  as 
regularly  as  after  their  first  fracture. 

In  considering  the  propriety  of  straightening  or  rupturing  the  callus,  it  be- 
comes interesting  to  inquire  into  the  degree  of  force  requisite  to  produce  it. 
M.  Jacquemin  in  his  Thesis,*  which  is  understood  to  embody  the  views  of 
Dupuytren  on  this  subject,  has  endeavoured  to  represent  by  weights  the 
force  necessary  to  break  the  callus  in  its  difTerent  periods,  and  the  result  of 
his  experiments  are  in  the  highest  degree  interesting,  as  showing,  that  at  a 
period  when  the  fractured  limb  is  ordinarily  removed  from  the  retentive  ap- 
paratus, rupture  of  the  callus  will  occur  upon  the  application  of  a  moderate 
degree  of  force. 

The  short  end  of  a  femur  which  was  surrounded  by  a  regular  callus,  taken 
from  an  adult  on  the  45th  day  after  a  fracture,  was  fixed  horizontally  upon 
a  table  in  such  a  way  that  the  callus  projected  from  it;  a  scale  beam  being 
attached  to  the  extremity  in  which  weights  were  gradually  placed.  At  56 
pounds  the  part  bent  without  tearing,  and  at  the  60th  pound,  the  callus  was 
completely  ruptured.  In  a  second  experiment  a  callus  of  59  days  was  torn 
ofT  at  the  56th  pound.t 

*  No.  140.    Paris,  1822,  quoted  from  Laugier's  Thesis. 

t  [From  the  manner  in  which  these  experiments  seem  to  have  been  tried,  the  weight 
does  not  represent  the  force.  The  bone  was  arranged  as  a  lever,  and  the  weight  acted 
with  advantage. — Ed.J 


1842.]  Norris  on  Deformities  after  Fractures.  309 

Previous  to  the  appearance  of  M.  Jacquemin's  work,  Bosch  and  (Esterlen 
had  experimented  upon  bones  after  fracture  in  a  somewhat  similar  way,  and 
conclusively  proved  that  the  callus  even  when  more  ancient  than  in  the  expe- 
riments already  cited,  gave  way  upon  the  application  of  force  sooner  than 
the  original  bone. 

The  leg  of  an  ox,  three  years  old,  which  had  become  firmly  consolidated 
after  fracture  that  had  occurred  28  wrecks  previously  with  shortening  of 
the  limb  to  the  extent  of  an  inch  and  a  half,  was  fixed  by  its  extremities  on 
two  pieces  of  plank;  the  screw  of  a  jack  was  then  applied  on  the  convex 
surface  of  the  callus,  which  was  fractured  by  a  few  turns  of  its  handle  with- 
out the  production  of  splinters.  The  bone  of  the  opposite  leg,  treated  in  the 
same  way,  required  the  application  of  much  more  force  to  produce  its  frac- 
ture. 

The  thigh  of  a  goat  of  two  years  old,  which  had  been  fractured  fifteen 
months  and  a  half  previously,  and  become  firmly  consolidated  with  deform- 
ity, was  submitted  to  the  action  of  ffisterlen's  machine,  and  after  a  few  turns 
of  the  screw  the  callus  was  fractured  transversely  in  its  middle.  In  a  third 
experiment  the  humerus  of  a  woman,  aged  81,  which  was  firmly  united  six 
weeks  after  its  fracture,  was  fixed  upon  two  blocks  at  a  little  distance  one 
from  the  other,  the  callus  projecting  between  them,  and  by  pressure  made 
with  a  round  stick  held  in  the  hands  of  the  operator,  a  clean  fracture  of  the 
callus  was  produced. 

Besides  these  direct  experiments  upon  the  callus,  numerous  observations 
of  the  accidental  rupture  of  bones  united  after  fracture  might  be  adduced,  to 
show  that  for  a  length  of  time  after  consolidation  of  the  original  injury,  rup- 
ture of  the  callus  is  feasible,  is  generally  cured  promptly,  and  has  been  often 
followed  by  marked  benefit  to  the  patient. 

The  possibility  of  straightening  or  of  rupturing  the  callus  after  its  deposite 
being  admitted,  a  question  arises  as  to  whether  or  not  it  should  be  preceded 
by  any  preparatory  local  treatment,  with  the  view  of  producing  softening  of 
this  substance.  Nearly  all  of  the  older  writers  recommend  the  use  of  fo- 
mentations, cataplasms,  ointments,  mercurial  plasters,  or  warm  bathing,  with 
a  view  not  only  to  their  relaxing  efifects  upon  the  soft  parts,  but  also  for 
those  upon  the  callus,  which  they  believed  to  become  more  supple,  and  apt 
to  give  way  more  easily  after  their  employment.  Of  these  applications,  the 
moderns  have  found  some  to  be  altogether  without  value,  while  others  of 
them  have  been  thought  by  practitioners  of  note  to  merit  the  notice  claimed 
for  them  in  certain  stages  of  the  formation  of  callus.  According  to  Duhamel, 
the  use  of  douche  baths  produces  such  powerful  effects  in  mollifying  recently 
deposited  callus,  as  to  bring  about,  if  often  repeated,  the  complete  separation 
of  the  fractured  fragments.  Richter  asserts  the  repeated  use  of  warm  baths 
to  be  a  powerful  means  of  softening  the  callus  of  firmly  consolidated  frac- 
tures, particularly  in  those  of  rather  advanced  age,  and  Brieske*  and  other 

*  Gazette  Medicale,  June  8,  1839. 


310  Norris  on  Deformities  after  Fractures,  [Oct. 

writers,  affirm  the  use  of  the  mineral  waters  of  Carlsbad  and  Barege,  to  pro- 
duce in  a  remarkable  degree  softening  of  this  substance.  Dupuytren,  too, 
whose  practical  judgment  and  close  observation  of  facts  must  be  unquestion- 
ed by  all,  was  fully  persuaded  of  their  good  effects,  and  never  attempted  the 
straightening  of  a  deformed  callus  in  the  lower  limbs,  without  enveloping 
the  part  for  several  days  previously  in  emollient  cataplasms,  and  strictly  en- 
joining the  use  of  local  baths — so  firm  indeed  was  his  conviction  in  the 
efficacy  of  bathing  for  this  purpose,  that  M.  Laugier*  affirms,  that  for  fear 
of  producing  this  effect  he  has  often  refused  to  allow  baths  to  his  patients, 
who  were  convalescing  after  fractures.  These  means,  however,  can  be  of 
avail  only  before  the  deposite  of  the  definitive  callus,  and  must  be  more 
useful  the  nearer  we  approach  the  period  of  original  injury,  and  it  would  be 
evidently  improper  to  delay  for  any  length  of  time  an  attempt  to  rectify  a 
bad  position  of  a  limb  in  order  to  make  trial  of  them,  where  a  comparatively 
long  period  had  already  elapsed  from  the  occurrence  of  the  accident. 

It  is  a  matter  of  much  importance  to  determine  accurately  the  cases  to 
which  re-fracture  of  the  limb  is  applicable — more  particularly  the  precise 
degree  of  deformity  demanding  it,  and  the  lapse  of  time  after  which  it  would 
be  proper  to  undertake  the  operation.  The  recorded  cases  of  the  operation 
have  been  most  generally  in  young  and  robust  subjects  where  the  callus  was 
still  recent,  and  where  the  deformity  was  either  considerable,  or  interfered 
more  or  less  with  the  use  of  the  member.  The  procedure  however,  is  not 
adapted  to  all  cases  of  irregularly  united  bones.  It  is  only  where  an  angular 
deformity  exists,  arising  from  the  union  of  the  fragments  by  their  extremities, 
that  rupture  of  the  uniting  medium  can  be  attempted  with  any  good  prospect 
of  success.  Where  there  is  shortening  of  the  extremity  from  the  ends  of 
the  bones  slipping  past  each  other,  even  supposing  that  the  rupture  could  be 
effected,  union  in  the  majority  of  cases  would  not  follow  in  consequence  of 
the  extremities  having  become  rounded  and  smooth. 

The  observations  of  rupture  of  the  callus,  detailed  in  the  work  of  (Esterlen, 
either  by  the  hand  alone,  or  with  the  aid  of  a  machine,  amount  to  seventeen 
in  number,  of  which,  ten  were  in  the  femur,  five  upon  the  leg,  and  two  on  the 
arm,  in  none  of  which  did  any  very  severe  symptoms  follow  the  operation. 
Seven  of  these  seventeen  cases  were  in  children,  and  ten  in  adults.  The 
greatest  length  of  time  which  had  elapsed  between  the  period  of  fracture  and 
that  of  the  operation,  was  six  months,  the  shortest  time,  one  month.  The 
longest  period  required  for  the  cure  after  rupture,  was  twenty  weeks,  the  short- 
est period,  four  weeks,  and  in  most  of  the  cases  operated  on,  very  considerable 
deformity  and  shortening  are  stated  to  have  been  present.  In  no  case  did  union 
fail  to  take  place  after  it,  and  in  all,  great  benefit  is  reported  to  have  followed  it. 

In  the  Gazette  Medicate  for  1840,  three  cases  are  detailed  by  Mr. 
Pfluger,    which  go  to  confirm  completely  the  statements  made  by  (Ester- 

*  Des  Cals  DifFormes,  These.    Paris,  1841,  p.  41. 


1842.]  Norris  on  Deformities  after  Fractures,  311 

len.  The  first,  was  the  case  of  a  man  astat,  64,  who  fractured  his  leg, 
and  who,  in  consequence  of  bad  treatment  was  unable  afterwards  to  walk 
without  crutches.  The  patient  desired  to  have  the  leg  broken  over,  which 
operation  was  done  by  M.  Bosch,  after  the  method  of  CEsterlen;  it  had  per- 
fect success,  and  ten  weeks  after  the  new  fracture,  the  patient  could  walk 
well,  having  but  slight  shortening. 

The  second  case  was  that  of  a  boy  aetat.  16,  with  a  fracture  of  the  femur 
in  its  middle  part.  Consolidation  had  taken  place  with  the  fragments  cross- 
ing each  other,  with  inclination  of  the  inferior  end  outwards  and  forwards, 
and  shortening  to  the  extent  of  eleven  centimetres;  artificial  rupture  was 
practised,  and  extension  afterwards  made  use  of.  In  two  months,  consolida- 
tion was  perfect,  the  two  members  being  of  equal  length. 

The  third  case,  was  a  youth  aetat  17,  with  fractured  femur,  the  frag- 
ments of  which  had  united  at  a  considerable  angle.  The  limb  was  shortened 
8  centimetres,  and  the  patient  scarcely  able  to  touch  the  ground  with  the 
point  of  his  toes.  Eighteen  weeks  after  the  accident,  Dr.  Gruel  ruptured 
the  callus  with  the  machine  of  OEsterlen.  Extension  was  afterwards  made 
upon  the  limb,  and  at  the  end  of  three  months  the  patient  was  moving  about 
on  crutches,  with  a  shortening  of  only  six  millimetres, 

M.  A.  Thierry  has  very  recently  recorded  [V Experience,  Nov.  1841)  the 
case  of  a  fractured  radius  which  was  straightened  by  rupturing  the  callus,  after 
perfect  consolidation  attended  with  much  deformity. 

According  to  Velpeau,*  M.  Jacquemin  proves  that  the  dangers  of  artificial 
rupture  have  been  singularly  exaggerated,  and  he  himself  thinks  it  shown 
beyond  question,  that  bones  newly  consolidated  are  more  easily  fractured  at 
the  point  of  primitive  injury  than  elsewhere,  and  holds  as  a  general  rule,  that 
the  second  fracture  becomes  consolidated  more  easily  and  promptly  than  the 
primitive  one.  He  would  limit  us,  however,  to  three  months,  for  attempts  upon 
limbs  presenting  simple  shortening  from  the  fragments  passing  each  other, 
though  he  looks  upon  efforts  to  rupture  angular  deformities,  always  allowable, 
however  long  the  period  which  may  have  elapsed  since  consolidation  has  oc- 
curred. 

Though  generally  unattended  with  dangerous  consequences,  yet  still  it  is 
well  to  recollect  that  these  have  occasionally  followed  rupturing  of  the  callus. 
Haly  Abbas,  as  already  mentioned,  relates  that  in  an  old  man  of  70  years  of 
age,  where  a  re-fracture  was  made  to  remedy  a  deformed  thigh,  death  occurred 
from  the  effects  of  the  operation.  Morgagni  gives  a  like  instance,  and  Lau- 
gier  asserts, t  that  a  similar  result  has  been  recently  observed  in  Germany. 
The  callus  in  this  case  was  of  nine  months  duration,  and  the  femur  the  seat 
of  the  injury;  the  re-fracture  was  produced  by  strong  extension  made  with 
the  pullies,  and  death  followed  an  hour  and  a  half  after  the  operation. 

The  treatment  after  re-fracture  of  a  bone  in  no  way  differs  from  that 


*  M6decine  Operatoire,  2d.  Ed.,  1839,  Tom.  1. 
t  Loc.  Cit.  p.  62. 


312  Norris  on  Deformities  after  Fractures.  [Oct. 

usually  employed  in  ordinary  solutions  of  continuity  of  the  bony  fibre.  If 
possible,  the  limb  should  be  at  once  stretched  to  its  proper  length,  or  at  any 
rate  brought  into  a  good  position,  and  so  retained  by  means  of  an  appropriate 
apparatus,  till  the  consolidation  is  effected,  care  being  taken  where  much 
sh/)rtening  has  existed,  to  make  the  extension  in  such  a  way  as  not  to  pro- 
voke severe  inflammatory  action. 

3.  Resection. — In  cases  where  objection  has  been  made  to  rupture  of  the 
callus,  where  this  is  impossible  to  attain  by  the  application  of  a  safe  degree 
of  force,  or  where  the  deformity  is  of  very  long  standing,  and  the  union  has 
taken  place  at  any  considerable  angle,  division,  or  resection  of  a  portion  of 
the  bone,  has  in  numerous  instances  been  performed,  and  followed  with  suc- 
cessful results.  As  these  operations  do  not  appear  to  have  received  the  atten- 
tion which  they  merit,  the  following  abstract  of  them,  embracing  most  of 
those  to  be  found  recorded,  is  given. 

Resection  of  a  projecting  portion  of  the  femur,  following  a  badly  set  frac- 
ture, is  reported  to  have  been  successfully  practised  in  1521,  upon  the  famous 
Jesuit,  Ignatius  de  Loyola,  then  aged  28  years. 

Gardiel,  the  translator  of  Hippocrates,  relates  in  that  work,  that  in  the 
case  of  his  own  nephew,  a  like  resection  was  performed  on  the  bones  of  the 
forearm,  and  that  the  operation  was  perfectly  successful. 

Wasserfuhr,  of  Stettin,  [Lancet,  vol.  1,  1828-9,  p.  521,  from  RusfsMaga- 
zin,)  in  1816,  separated  and  resected  the  femur,  in  a  child  aged  five  years,  to 
remedy  an  angular  deformity  of  that  bone  above  its  middle  part,  following 
a  badly  set  fracture.  The  fractured  bone  was  consolidated  in  such  a  manner 
as  to  form  nearly  a  right  angle,  and  the  limb  was  shortened  to  the  extent  of 
twelve  fingers  breadth.  The  operation  was  difficult,  and  followed  by  severe 
symptoms,  but  the  patient  recovered.  We  must  here  remark,  that  though 
successful,  we  do  not  think  any  similar  operation  to  be  either  called  for,  or 
ever  justifiable  in  a  child  of  five  years. 

Riecke,  in  1827,  {Archives  Generales,  September  1828,)  in  a  patient  aged 
20,  with  a  badly  united  fracture  of  the  femur — the  limb  being  shortened  nearly 
a  foot — incised  the  soft  parts  from  the  great  trochanter  to  the  external 
condyle,  divided  the  callus  with  a  saw,  and  afterwards  removed  the  end  of  the 
superior  fragment  of  the  bone.  A  perfect  cure  was  obtained  in  eight  months, 
the  member  having  been  restored  by  permanent  extension  to  nearly  its  natu- 
ral length. 

M.  Clemot,*  surgeon  in  chief  of  the  marine  at  Rochefort,  has,  in  two  in- 
stances, resected  portions  of  the  femur,  in  order  to  remove  great  deformities 
resulting  from  badly  treated  fractures.  The  first  case  was  in  a  child  in  whom 
the  treatment  by  extension,  though  persisted  in  for  several  months,  had 
failed.  The  operation  was  done  in  December,  1834,  A  longitudinal  inci- 
sion, two  inches  in  length,  was  made  over  the  callus,  and  the  bony  angle 

*  Arch.  Generales.  2me  t€v  Tom.  ii,  p.  235. 


1842.]  '^oxns  on  Deformities  after  Fractures,  313 

fairly  exposed.  The  fragments  had  united  at  an  angle  of  about  112  degrees. 
Spatulas  were  placed  beneath  the  bone  in  opposite  directions,  in  order  to 
protect  the  soft  parts,  and  the  angular  projection  protruded.  With  a  small 
saw,  a  section  perpendicular  to  the  axis  of  the  superior  fragment  was  made, 
including  but  two-thirds  of  its  thickness.  A  like  section  was  then  made  for 
the  inferior  fragment.  The  loss  of  substance  was  not  great,  and  was  at  the 
expense  of  the  callus.  The  limb  was  then  placed  in  a  good  position,  and 
the  fragments  maintained  in  apposition.  Seventy  days  after  the  operation 
the  child  was  removed  to  Bordeaux,  having  the  limb  straightened  and  length- 
ened. 

The  second  case,  was  that  of  a  husbandman,  astat.  27,  who  fourteen 
months  and  a  half  previous  to  the  operation,  had  met  with  a  fracture  of  the 
left  thigh,  a  little  above  its  middle.  After  the  cure,  the  femur  remained 
deformed,  and  bent  to  an  angle  of  130  degrees — the  summit  of  this  appear- 
ing at  the  external  and  anterior  part.  The  limb  was  shortened  five  inches; 
the  leg  and  the  foot  carried  inwards,  and  the  patient  unable  to  walk.  The 
callus  was  perfectly  firm.  Resection  of  the  angular  projection  was  made  in 
February,  1835,  and  the  limb  afterwards  placed  on  the  double  inclined  plane. 
Seventy  days  after  the  operation,  the  inclined  plane  was  removed,  the  leg 
and  thigh  being  still  kept  in  a  state  of  semi-flexion,  and  but  slight  motion 
allowed.  The  date  of  his  discharge  is  not  mentioned,  though  it  is  stated 
that  he  was  able  to  support  the  weight  of  his  body  on  the  limb,  and  had  a 
lameness  scarcely  perceptible. 

In  a  case  of  deformity  after  a  fractured  leg,  in  which  the  sharp  edge  of 
the  tibia  projected  against  the  skin,  so  as  to  occasion  much  pain  and  deform- 
ity, and  considerable  difficulty  in  setting  the  foot  against  the  ground,  Mr. 
Dunn  of  Scarborough,  [Medico- Chincrgical  Transactions,  vol.  xii,  p.  181,) 
in  1821,  made  a  semilunar  incision  of  the  integuments,  turned  them  back- 
wards, and  with  Key's  saw  amputated  the  sharp  angle  of  the  bone.  The 
leg  by  this  course  was  made  much  straighter,  and  the  patient  afterwards 
walked  well. 

In  1827,  a  case  fell  under  the  notice  of  Mr.  Duncan,  (Lancet,  1827-8, 
vol.  i.  p.  25,)  in  which  a  fragment  of  the  femur  of  a  man  aged  22,  projected 
outwardly,  at  a  point  above  the  middle  of  the  thigh,  to  so  great  a  degree 
that  it  seemed  scarcely  covered  by  soft  parts,  and  formed  with  the  other  por- 
tion of  the  bone  nearly  a  right  angle.  This  deformity  had  followed  the 
treatment  of  a  compound  fracture  of  the  thigh  received  a  year  previously, 
and  almost  entirely  prevented  the  man  from  walking.  Mr.  D.  after  expos- 
ing this  projecting  piece  of  bone,  which  was  externally  sharp,  and  nearly  an 
inch  and  a  half  in  length,  cut  it  off  with  a  large  pair  of  bone  plyers.  The 
edges  of  the  wound  united  by  the  first  intention,  and  the  patient  did  well. 

In  1823,  Dr.  Warren  qf  Boston  (communicated  to  author  by  Dr.  J.  Ma- 
son Warren)  sawed  out  a  cuneiform  fragment  of  the  tibia  at  its  most  promi- 
nent part,  in  a  case  of  deformity  following  a  fracture  which  had  occurred 
No.  VIII.— October,  1842.  27 


314  Norris  on  Deformities  after  Fractures,  [Oct. 

nine  months  previously  at  sea.  The  patient  was  22  years  old,  and  the  leg 
was  greatly  curved  inwards.  After  removal  of  the  wedge,  the  base  of  which 
was  two  inches  in  length,  the  fibula  was  broken  by  manual  force,  and  the 
parts  straightened  and  secured  by  splints.  The  union  was  perfected  in  four 
weeks. 

Dr.  Parry  of  Indiana,  {Jim.  Journ.  of  Med.  Sci.  vol.  ix.  1839,)  in  a  young 
subject,  who  had  met  with  a  fractured  leg  two  years  before,  which  had  been 
suffered  to  unite  at  an  angle  almost  equal  to  a  right  angle,  in  1838  exposed 
the  bones,  and  sawed  a  little  cuneiform  block  out  of  the  angle  of  each;  in  a 
little  more  than  two  months  after  the  patient  was  discharged  cured,  the  leg 
being  straightened,  and  increased  three  inches  in  length. 

Mr.  Key,  in  October,  1838,  (Guy^s  Hospital  Beports,  April,  1839,)  per- 
formed a  similar  operation  upon  a  gentleman  who  met  with  a  fracture  of  the 
tibia,  in  August  1835.  The  shortening  occasioned  by  the  deformity  in  this 
case  was  such  as  to  cause  the  patient  to  walk  on  his  toes,  the  heel  being 
raised  an  inch  and  a  half,  when  he  stood  upright.  The  tibia  was  divided  on 
the  14th  of  October,  and  by  the  18th  of  January  following,  the  bone  had 
firmly  united.  The  limb  having  acquired  a  good  position,  and  appearing  but 
little  less  than  its  fellow. 

Professor  Portal,  of  Palermo,  [Jim.  Journ.  of  Med.  Sci.  vol.  iii.  N.  S. 
1842,)  has  also  operated  successfully  on  two  like  cases.  The  first  was  in  a 
patient  aged  32,  in  whom  a  fracture  of  both  bones  of  the  leg,  near  their 
middle,  had  united  in  an  irregular  manner.  An  incision  was  made  over  the 
angular  projection,  and  about  an  inch  of  the  bone  removed  by  the  chain  saw. 
The  limb  was  then  carefully  extended,  and  a  cure  procured  in  forty-eight 
days,  the  wound  having  united  by  the  first  intention.  Very  little  shortening 
occurred. 

The  second  case,  was  that  of  a  woman  in  whom  the  fractured  ends  of  the 
femur  had  united  so  as  to  form  an  angle  at  the  point  of  union.  The  ends  of 
the  bone  were  cut  down  on,  and  an  inch  and  a  half  removed  from  the  upper 
fragment,  after  which  half  an  inch  was  sawn  off  from  the  lower.  The  limb 
was  maintained  in  a  state  of  permanent  extension.  Fifty-five  days  after- 
wards she  was  dismissed  cured,  with  the  limb  perfectly  serviceable,  though 
shortened  to  the  extent  of  two  finger-breadths. 

In  1839,  a  boy  aged  fourteen  years,  fell  under  the  notice  of  Dr.  Stevens, 
(communicated  in  a  letter  from  Dr.  Watson  of  New  York,)  in  whom  the  leg 
had  been  fractured  eight  years  previously,  and  had  been  suffered  to  unite  in 
such  a  way  that  its  lower  part  was  bent  inwards  and  backwards,  nearly  at 
right  angles  with  the  upper.  For  the  purpose  of  remedying  this  deformity, 
Dr.  S.  after  exposing  the  bones,  sawed  out  a  wedge-shaped  piece  from  the 
angle  of  the  tibia,  and  another  from  that  in  the  fibula,  and  then  after  a  sub- 
cutaneous division  of  the  tendo-achillis,  straightened  the  leg  and  brought  the 
bones  into  careful  apposition.  The  case  was  subsequently  treated  as  one  of 
compound  fracture,  at  first  by  Amesbury's  apparatus,  and  afterwards  by  the 


1842.]  Norris  on  Deformities  after  Fractures,  315 

starched  bandage.  Notwithstanding  every  attention,  however,  union  failed 
to  occur,  and  about  a  year  after  the  attempt  to  straighten  the  limb  had  been 
made,  amputation  became  necessary,  and  was  successfully  done  by  Dr. 
Watson. 

In  a  patient  23  years  of  age,  affected  with  a  deformed  and  shortened 
leg  consequent  upon  an  unsuccessfully  treated  fracture,  received  ten  months 
previously.  Dr.  Thomas  D.  Miitter  [Jim.  Journ.  of  Med.  Sci.  vol.  iii.  N.  S. 
1842,)  resected  the  extremities  of  the  bones  with  success;  the  patient  walk- 
ing without  difficulty  eight  months  after  the  operation. 

In  1841  Dr.  J.  R.  Barton  {Medical  Examiner,  No.  2,  1842)  operated  for 
the  relief  of  deformity  of  the  leg  following  a  fracture.  In  this  case,  the  ex- 
tremity of  the  upper  fragment  of  the  tibia  projected  inwards,  overlapping 
the  lower  one  about  half  an  inch,  and  the  limb  besides  being  shortened  and 
deformed,  was  weakened,  and  the  footing  of  the  patient  rendered  uncertain, 
the  whole  foot  being  thrown  outwards.  The  parts  being  exposed,  the 
extreme  ends  of  the  bone  were  sawn  off,  and  the  transverse  bridges  which 
connected  the  tibia  and  fibula  together,  were  removed  by  the  chisel  and  bone 
nippers,  and  the  fragments  brought  into  perfect  coaptation,  and  so  retained. 
By  the  end  of  the  fourth  week,  bony  union  was  so  far  advanced  as  to  admit 
of  the  limb  being  rolled  about  the  pillow,  and  on  the  fortieth  day,  he  arose 
from  his  bed,  with  a  straight  and  sound  limb. 

After  the  cure  of  fractures,  points  of  new  bone  are  at  times  thrown  out  in 
such  a  way  as  either  to  give  rise  to  much  suffering,  or  prevent  proper  motion 
in  the  joints,  and  in  these  cases  operative  measures  have  been  resorted  to  for 
their  cure.  Mr.  Alcock  [Medico- Chirurg,  Transactions,  vol.  xxiii.  p,  315) 
relates  the  case  of  a  gentleman  who  in  1835,  was  thrown  from  a  gig,  and 
fractured  the  upper  third  of  the  ulna  into  the  elbow  joint.  Considerable 
swelling  supervened,  and  the  fracture  was  not  discovered  until  some  union 
had  taken  place,  and  that  at  such  an  angle  that  a  sharp  peak  projected  at  the 
posterior  surface,  rendering  any  attempt  at  flexion  painful  in  the  extreme, 
from  the  stretching  of  the  skin  over  the  sharp  end  of  bone.  Gentle  passive 
motion  and  friction  had  been  adopted,  but  the  time  had  arrived,  Mr.  A.  be- 
lieved, when  more  force  was  required,  and  no  perceptible  advantage  could 
be  gained  without  it.  This  opinion  was  founded  upon  the  diagnosis,  that 
mere  ligamentous  bands,  uniting  the  fragments  at  an  angle,  prevented  the 
flexion  of  the  arm,  and  that  it  required  regulated,  but  considerable  force,  to 
elongate  these,  and  before  it  could  be  attempted  removal  of  the  projecting 
sharp  end  of  the  bone  was  necessary.  Sir  A.  Cooper  concurring  in  this 
view  of  the  case,  the  projecting  end  of  the  bone  was  removed,  and  as  soon 
as  the  wound  was  healed,  a  moderate  degree  of  forcible  extension  was  em- 
ployed. The  case  rapidly  improved,  and  he  recovered  the  perfect  use  of  the 
part. 

A  nearly  similar  operation  was  done  with  success,  at  the  urgent  request 
of  the  patient,  upon  a  female  at  La  Charite,  by  M.  Velpeau,  {Med.  Operat, 


316  Arnold's  Observations  on  Black  Vomit,  [Oct. 

2me  Ed.  Tom,  2,  p.  559,)  and  a  like  method  is  said  to  have  been  employed 
upon  the  femur  in  England,  by  Mr.  Dawson,  with  a  happy  result. 


Art.  VII. — Tivo  cases  of  Black  Vomit,  tvith  Observations.     By  Richard 
D.  Arnold,  M.  D.,  of  Savannah. 

A  RECORD  of  the  two  following  cases  may  not  prove  uninteresting  to  the 
medical  men  of  the  north,  as  at  least  adding  to  the  facts  in  relation  to  yellow 
fever  or  black  vomit. 

The  first  case  was  that  of  a  lad  named  Seatle,  who  arrived  at  Savannah 
from  Demerara,  in  March  1841.  I  was  at  that  time  Health  Officer  of  the  port 
of  Savannah;  and,  as  my  mind  had  been  long  made  up  as  to  the  non-conta- 
gion of  this  disease,  after  my  official  visit  to  the  ship  in  which  he  came,  I 
directed  the  master  of  the  vessel  to  send  him  up  to  the  Savannah  Poor 
House  and  Hospital  and  Marine  Hospital,  of  which  institution  I  am  the 
senior  physician,  and  where  he  came  under  my  care. 

I  shall  now  copy  the  case  as  it  stands  recorded  in  my  note  book. 

March  SOth,  1841. — Entered  this  afternoon,  a  boy,  named  Seatle,  setat. 
17,  English  by  birth,  arrived  yesterday,  from  Demerara,  after  a  passage  of 
eighteen  days.  When  eleven  days  out  was  taken  sick;  several  of  the  crew 
were  taken  sick,  and  one  died  just  before  reaching  this  port. 

As  far  as  can  be  gathered  from  him,  was  seized  first  with  pain  in  the  back 
and  loins,  and  cephalalgia.  Has  been  treated  with  salts,  calomel,  and  jalap, 
and  has  taken  four  pills  at  four  different  times  (no  doubt  drastic,  as  each  one 
purged).     Yesterday  took  ten  grains  of  calomel  and  flaxseed  tea. 

Present  Condition. — Skin  little  above  natural  temperature;  pulse  quick, 
frequent,  100.  Sensibility  in  epigastric  region  very  acute,  he  crying  out 
upon  the  bare  weight  of  the  hand  being  placed  upon  it. 

He  ejects,  by  belching  up  from  stomach,  a  matter  of  a  coffee-ground  ap- 
pearance, of  a  peculiar  sour  smell,  sticking  to  the  sides  of  the  vessel,  a7id 
offering  not  a  single  trace  of  bile.  Tongue  has  a  whitish  fur,  but  is  by  no 
means  remarkable.     I  pronounce  the  case  to  be  one  of  black  vomit. 

Treatment. — Blister  8 x  10  to  epigastrium;  R. — Calomel,  grs.  xii;  opium, 
gr.  i. — M.  divide  in  six  powders,  one  every  two  hours.  A  tablespoonful 
of  soda  water  every  two  hours. 

March  31. -^Patient  says  he  feels  easier  this  morning,  complains  of  no- 
thing but  weakness  when  he  rises.  Upon  close  examination  says  he  has  a 
pain  in  his  back,  extending  from  shoulder  blade  to  pelvis,  and  that  his  head 
aches;  tongue  is  rather  pointed,  and  red  at  edges.  Inside  of  lips  red,  and 
appears  as  if  blood  was  exuding.    Blackish  brown  fur  at  base,  slight  yellow 


1842.]  Arnold'' s  Observations  on  Black  Vomit.  317 

tinge  of  whites  of  eyes  and  of  the  skin  of  the  trunk;  mutters  and  talks  a  good 
deal;  skin  hot;  pulse  100  to  104,  small,  quick.  Still  ejects,  without  any- 
retching  effort,  the  peculiar  coffee-ground  matter  in  a  watery  sanguinolent 
fluid.  Urine  scanty.  One  stool  since  his  entrance.  Dress  blister  with 
basiUcon;  continue  powders;  give  ice  in  small  lumps;  iced  soda  water; 
give  very  litde  liquid  at  a  time. 

F.  M. — Symptoms  much  the  same.  Enema  of  a  decoction  of  seneka 
snakeroot;  continue  powders;  blisters  to  calves  of  legs. 

April  1st. — Has  passed  the  black  fluid  in  his  stools;  the  quantity  passed 
is  very  considerable.  He  appears  delirious,  mutters  to  himself,  dozes  every 
few  minutes,  can  be  aroused  to  answer  questions;  does  not  know  where  he 
is;  asks  if  he  is  in  Demerara  now.  The  yellow  tinge  of  the  conjunctiva 
has  deepened,  as  also  of  the  skin.  Tongue  dry;  florid  at  edges  and  bloody, 
as  are  also  the  lips.  Still  eructates  and  gulps  up  the  black  vomit.  Cannot 
bear  the  slightest  pressure  upon  epigastrium;  pulse  112,  small,  rather  weak 
and  quick;  hands  and  feet  cool;  skin  of  body  about  natural  in  temperature; 
has  had  two  stools,  one  about  a  half  hour  after  the  injection  last  night,  the 
other  about  3  A.  M.,  both  similar  in  appearance  to  the  matter  from  the 
stomach;  says  he  has  very  litde  headache;  groans,  but  cannot  explain  why; 
talks  about  getting  his  clothes  and  going  to  England.  Stop  all  medicine; 
give  a  wine-glass  of  iced  champaign  every  half  hour. 

P.M. — Patient  about  as  this  morning;  pulse  116;  rather  fuller  than  at 
that  time;  still  ejects  the  black  vomit,  but  not  quite  so  abundantly  as  before. 
Is  delirious,  but  can  be  aroused,  and  his  attention  fixed;  recognizes  his 
brother-in-law,  and  converses  sensibly  with  him;  continue  champaign. 

About  midnight  he  died. 

Post  mortem  appearances  about  ten  hours  after  death.  A  well  formed 
muscular  body  of  the  medium  size;  skin  of  a  yellowish  olive  tinge;  no 
blotches  or  eruption  on  the  body;  lips  and  under  surface  of  neck,  trunk  and 
limbs  of  a  livid  hue. 

Liver  pale  and  ash-coloured  on  its  entire  surface;  the  omentum  was  much 
injected,  and  apparently  inflamed.  An  incision  was  made  in  the  upper  por- 
tion of  the  liver;  it  was  ash-coloured  throughout.  The  acini  were  very  dis- 
tinct, and  there  was  a  marked  deficiency  of  blood  in  it.  The  gall-bladder 
was  contracted  and  inflamed,  filled  with  a  greenish  black,  very  viscid  bile. 
The  internal  coat  was  much  injected;  spleen  not  appreciably  affected;  per- 
haps there  was  less  blood  than  usual  in  it. 

The  stomach  was  cut  open  along  its  greater  cuwfiture;  it  contained  black 
vomit,  i.  e.  a  fluid  containing  a  sediment  resembling  well  parched  coffee- 
grounds,  and  giving  not  the  slightest  trace  of  bile;  (this  can  be  tested  and 
was,  by  dipping  a  piece  of  white  paper  in  it;  if  there  were  the  least  bile,  a 
yellow  or  a  greenish  tinge  would  be  giyen  to  the  paper.)  The  mucous  mem- 
brane was  universally  injected,  being  in  some  spots  of  a  deeper  red  than  in 
others.     It  was  very  much  corrugated  in  the  larger  curvature.     All  over  the 

27* 


318  Arnold's  Observations  on  Black  Vomit.  [Oct. 

mucous  membrane  of  the  stomach  there  were  ulcerations  of  the  colour  of 
black  vomit  of  various  shapes  and  sizes.  Some  of  the  ulcerations  perforated 
the  mucous  membrane,  others  were  superficial.  Just  at  the  pyloric  orifice  the 
membrane  was  sound.  To  prove  that  the  mucous  membrane  was  the  mem- 
brane inflamed,  a  piece  was  carefully  dissected  off,  and  the  red  vessels  were 
seen  ramifying  through  it.     It  was  thickened. 

Viewed  through  a  microscope,  the  ulcerations  appeared  to  be  the  patulous 
mouths  of  small  vessels.  In  some  of  the  ulcerations  this  was  apparent  to 
the  naked  eye.  With  the  microscope  this  appearance  was  distinct  and  satis- 
factory to  all.  The  parts  were  carefully  washed.  The  mucous  membrane 
was  then  squeezed  on  its  most  inflamed  portions^  lohere  it  was  not  ulce- 
rated, and  blood  exuded.  The  ulcerated  portions  were  then  squeezed,  and 
a  blackish  fluid  mixed  with  blood  exuded.  Small  black  flocculi  could  be 
seen  sticking  in  the  patulous  mouths  of  the  small  vessels  described  above. 
This  was  repeated  so  often  as  to  leave  no  doubt  on  the  subject. 

The  small  intestines  were  of  a  livid  colour  and  filled  with  black  vomit. 
The  mucous  membrane  of  the  duodenum  was  slightly  injected  just  below  the 
pyloric  orifice.  For  about  three  inches  below  the  glands  of  Peyer  were  very 
much  enlarged.  In  one  spot  of  the  small  intestines  two  or  three  of  the  rugae 
were  discoloured  with  bile;  but  none  could  be  scraped  off  in  any  portion  of 
the  whole  intestinal  canal.     Kidneys  were  natural. 

The  lungs  were  very  much  congested  and  soft;  heart  pale  and  of  a  natural 
size. 

Brain  and  membranes  injected,  natural  as  to  consistence. 

I  was  assisted  in  the  post-mortem  examination  by  my  colleague,  Dr.  W. 
Gaston  Bullock,  and  by  Dr.  J.  Gordon  Howard. 

Observations. — I  have  selected  this  case  out  of  the  number  in  my  note 
book,  because  it  originated  in  a  tropical  climate,  and  came  under  my  obser- 
vation at  a  season  of  the  year  when  our  city  is  as  completely  exempt  from 
bilious  or  climate  fever  of  any  kind,  as  any  portion  of  the  north.  I  was 
thus  enabled  to  give  the  case  a  careful  attention,  which  is  almost  impossible 
in  the  sickly  season  of  our  climate  when  our  Hospital  contains  ranging  from 
40  to  60  beds,  nearly  all  of  climate  fever;  and  where  the  physician  has  to 
perform  all  the  duty,  shared  at  the  north  between  the  attending  and  resident 
physicians. 

This  case,  moreover,  coincides  in  its  general  features  with  all  those  I 
have  seen  since  my  practice  in  this  city,  and  with  those  which  I  examined 
while  pursuing  my  medical  studies  under  Dr.  Waring. 

Dr.  Waring,  in  1827,  pointed  out  to  me,  m  the  dead  body,  as  the  peculiar 
characteristics  of  yellow  fever,  the  pale  appearance  of  the  liver,  its  deficiency 
of  blood,  amounting  to  a  comparative  dryness,  and  the  entire  absence  of  all 
biliary  secretion.  In  all  cases  that  I  have  ever  examined,  with  the  exception 
of  viscid  bile  in  the  gall-bladder,  in  vain  did  I  ever  look  for  the  slightest  trace 
of  bile  in  the  dead  body.     The  same  is  true  of  the  excretions  during  life. 


1842.]  Arnold's  Observations  on  Black  Vomit.  319 

Perhaps  there  may  be  bile  in  the  very  incipiency  of  the  attack,  before  a 
physician  is  called;  but  in  every  case  that  has  ever  come  under  my  notice, 
that  has  terminated  in  black  vomit,  the  absence  of  bile  in  the  excretions 
has  been  the  distinctive  characteristic  of  the  dise<ise.  In  this  case  the  fact 
of  black  vomit  coming  directly  from  the  inflamed  capillaries  of  the  mucous 
coat  of  the  stomach,  is  certainly  clearly  demonstrated.  I  never  before  met 
with  it  so  satisfactorily  exhibited.  This  I  attribute  to  the  fact  of  the  patient 
having  been  sick  a  much  longer  time  than  is  general  with  those  who  die  of 
yellow  fever  in  our  fall  months,  the  only  time  in  which  it  can  ever  be  met 
with  in  our  city. 

The  symptoms  during  life  most  emphatically  point  out  the  stomach  as  the 
principal  seat  of  the  disease.  In  every  case  that  I  ever  saw,  the  sensibility 
of  the  epigastrium  was  most  excessive.  In  this  case  it  existed  to  a  high 
degree.  Very  large  quantities  of  black  vomit  were  thrown  up  during  the 
two  days  and  a  half  the  patient  was  in  the  Hospital.  I  did  not  measure  it, 
but  judging  from  my  recollection  of  the  array  of  vessels  containing  it,  which 
were  preserved  by  the  steward  for  my  inspection,  it  must  have  amounted  to 
three  or  four  gallons.  The  fact  that  it  was  through  the  mucous  membrane 
of  the  stomach  that  this  large  evacuation  took  place,  certainly  points  it  out  as 
playing  a  most  important  part  in  the  disease.  What  is  black  vomit?  I 
answer,  a  blood,  altered  by  its  transition  through  the  capillaries  of  the  sto- 
mach, or  if  I  may  be  allowed  the  expression,  it  is  a  hemorrhagic  secretion 
from  its  mucous  membrane.  The  quantity  thrown  from  the  system  explains 
in  some  measure  the  paleness  of  the  liver.  The  physiological  axiom,  *'  ubi  irri- 
tatio,  ibi  affluxus,"  must  also  be  pressed  into  service  to  aid  in  the  explanation. 
The  blood  and  nervous  power  are  so  concentrated  in  the  mucous  coat  of  the 
stomach,  that  the  sympathetic  connection  existing  between  it  and  the  liver  is 
broken  up.  Let  that  irritation  of  the  stomach  be  lessened,  let  it  be  reduced 
from  the  high  grade  it  assumes  in  real  yellow  fever,  the  connection  between 
the  liver  and  stomach  is  renewed,  and  the  former  with  it,  resumes  its  sus- 
pended function  of  secretion.  It  is  to  elucidate  this  position  that  I  have 
selected  the  following  case. 

Case  II.— On  the  20th  Oct.  1841,  was  called  to  see  J.  M.  aetat.  40,  for 
many  years  a  resident  of  this  city.  He  was  taken  sick  on  Sunday  the  17th, 
with  a  chill.  He  took  a  nostrum,  called  Beckwith's  pills.  From  the 
first  he  had  great  irritability  of  stomach.  I  prescribed  a  sinapism  to  the 
epigastrium,  as  he  was  still  labouring  under  nausea,  and  an  ounce  of  ol. 
ricini,  as  soon  as  the  stomach  was  settled.  His  wife  informed  me  that  after 
taking  the  oil  he  threw  up  bile,  and  that  it  produced  bilious  passages.  I  did 
not  see  them  myself. 

On  the  morning  of  the  21st,  I  found  him  complaining  much  of  constant 
nausea.  His  pulse  was  slow,  60;  his  skin  cool  and  comfortable;  tongue 
very  slightly  furred  towards  the  root,  natural  in  colour.     I  directed  the  half 


S20  Arnold's  Observations  on  Black  Vomit,  [Oei, 

of  a  birds-eye  pepper  every  hour,  being  a  species  of  capsicum  which  is  very 
strong,  and  which  I  have  several  times  found  very  efficacious  in  allaying 
nausea,  when  there  was  no  fever.  I  also  directed  quinine,  as  he  had  had 
chills.  At  1,  P.  M.,  finding  him  still  very  much  nauseated,  stopped  the 
capsicum  and  quinine,  and  directed  another  sinapism  to  epigastrium.  At  5, 
P.  M.,  complained  of  a  burning  in  the  pit  of  the  stomach.  Mrs.  M.  said 
he  had  thrown  up  some  toast,  he  having  had  toast  water,  and  taken  a  mouth- 
ful of  the  toast.  On  being  exhibited  to  me,  I  found  that  he  had  thrown  up 
blackish  brown  flocculi,  mixed  with  a  viscid  mucus,  and  giving  no  trace  of 
any  bile.  The  bottom  of  the  basin  was  filled,  and  the  matter  adhered  to  the 
sides.  There  was  no  doubt  in  my  mind  of  its  being  genuine  black  vomit; 
but  of  this  I  took  care  not  to  inform  my  patient.  I  directed  a  large  blister 
to  epigastrium,  which  was  excessively  sensitive,  and  an  almost  total  absti- 
nence from  fluids,  the  mouth  to  be  merely  moistened.  As  I  had  prescribed 
large  doses  of  quinine  to  a  case  then  in  the  Hospital,  where  large  quantities 
of  black  vomit  had  been  ejected,  which  had  checked  it  for  a  time,  and  as 
there  was  an  absence  of  any  headache,  I  determined  to  try  its  eflicacy  in 
this  case.  I  directed  two  grains  instanter,  being  all  there  was  in  the  house. 
8  P,  M.  Found  he  had  rejected  the  quinine  as  soon  as  he  swallowed  it, 
and  therefore  had  not  repeated  it.  Had  also  thrown  up  more  black  vomit. 
Examined  a  passage  he  had  had  from  the  bowels:  it  was  serous,  dark,  with 
no  trace  of  bile  in  it,  either  green  or  yellow.  I  desisted  from  all  internal  reme- 
dies. At  4  A.  M.,  I  was  called  to  see  him.  He  had  again  vomited  black 
matter.  I  prescribed  calomel,  grs.  xii.  opium  gr.  i,  to  be  divided  in  six 
powders,  one  every  two  hours.  At  9  A.  M.,  22d  Oct.  I  saw  him  again. 
At  7  A.  M.,  he  had  vomited  more  black  matter.  I  told  him  to  swallow  no- 
thing but  the  powders,  and  to  rinse  his  mouth  with  pure  lemon  juice.  He 
followed  these  directions  implicitly.  In  the  evening  I  directed  a  flaxseed 
enema,  which  produced  a  dark  serous  passage.  On  the  23d,  A.  M.,  had 
had  no  return  of  vomiting.  For  thirty-six  hours  he  had  swallowed  nothing 
but  the  powders.  I  now  ventured  to  give  him  strained  gruel  by  the  tea- 
spoonful,  at  long  intervals.  At  3  o'clock,  A.  M.  of  the  23d,  I  was  sent  for. 
During  this  time  he  had  been  taking  the  powders  regularly.  I  was  alarmed 
and  almost  gave  him  up,  as  I  was  certain  that  he  would  not  have  sent,  unless 
he  had  had  a  return  of  the  vomiting.  On  arriving  at  the  house,  I  was  agreeably 
disappointed  as  to  the  vomiting,  but  found  that  he  had  two  stools  precisely 
similar  to  what  he  had  vomited,  viz.  genuine  black  vom.it.  Up  to  this  time, 
he  had  taken  thirty-six  grains  of  calomel,  and  three  of  opium.  I  thought 
this  enough  at  present,  as  his  gums  were  slightly  touched,  but  the  salivary 
glands  were  not  aflfected.  At  half  past  nine  he  was  quite  comfortable;  his 
pulse  w^as  at  60  constantly.  I  directed  a  grain  and  a  half  of  pure  calomel 
€very  two  hours.  At  4  P.  M.  I  was  sent  for.  He  has  a  great  deal  of 
phlegm  habitually  when  well,  and  in  hawking  it  up,  it  set  him  to  vomiting, 
and  he  threw  up  vitiated  green  bile.    This  1  hailed  as  the  harbinger  of  hope. 


1842.]  Arnold's  Observations  on  Black  Vomit,  321 

I  directed  a  purging  enema,  and  on  my  return  at  half  past  eight,  P.  M.  was 
shown  a  passage  containing  unequivocal  traces  of  black  vomit.  To-day  he 
has  confined  himself  to  flaxseed  tea  in  very  small  quantities.  I  prescribed 
two  grains  of  calomel  every  two  hours.  None  of  the  calomel  had  as  yet 
passed  the  bowels. 

25th,  \0  A,  M,  Has  taken  his  calomel  regularly,  but  as  yet  has  had  no 
passage  except  from  enemata.     Directed  a  purging  enema  at  night. 

26^/i.  The  two  passages  produced  by  the  enema  were  serous,  and  with- 
out any  traces  of  black  vomit.  B.  blue  mass,  xii.  grs.,  rhubarb,  xv. — 
M.  in  six  pills,  two  every  four  hours  until  an  evacuation  is  produced. 

21th,  A.  M. — Has  taken  ten  pills.  Last  night  I  directed  an  enema  to  be 
given  during  the  night;  it  produced  two  tolerably  copious  discharges.  There 
was  some  of  the  black  secretion  in  them,  mixed  with  mucus,  but  the  sides 
of  the  vessel  were  evidently  tinged  yellow  by  the  presence  of  bile.  This  is 
the  first  excretion  of  a  healthy  bilious  nature,  which  has  come  from  him; 
allowed  some  chicken  water.  P.  M.  quite  comfortable;  mouth  quite  sore 
from  the  mercury:  K.  Henry's  calcined  magnesia  and  cremor  tartar  aa,  a 
teaspoonful.  He  has  not  yet  had  any  passage  except  from  enemata.  I  have 
been  fearful  of  exhibiting  a  purgative  lest  the  stomach  should  become  excited 
and  a  relapse  take  place. 

2Sth.  The  last  dose  of  medicine  produced  the  desired  effect,  and  this 
morning  I  was  shown  the  welcome  sight  of  two  bilious  stools. 

29th,  Convalescing.  From  this  time  the  case  was  easily  manageable,  and 
in  a  kw  days  he  was  up. 

Observations. — In  this  case  the  external  symptoms  were  by  no  means 
indicative  of  the  extreme  danger  of  the  case.  Except  the  case  alluded  to  as 
at  the  Hospital,  I  had  not  met  with  a  single  case  of  black  vomit  during  the 
season,  and  I  had  not  the  slightest  suspicion  of  the  nature  of  this  case  until 
the  black  vomit  was  thrown  up.  When  I  saw  it,  I  considered  the  case 
hopeless,  for  the  recoveries  that  take  place  are  so  few,  as  to  render  death 
almost  certain.  But  I  thought  that  if  I  could  only  bring  the  liver  to  the 
secreting  point,  it  would  operate  favourably  on  the  case.  I  think  that  the 
wonderful  forbearance  of  the  patient  (who  is  an  intelligent  gentleman  of  this 
city)  in  taking  drink,  enabled  the  stomach  to  retain  the  small  doses  of  mer- 
cury, and  gave  it  a  chance  of  acting  on  the  system. 

But  my  object  has  not  been  to  enter  at  all  into  theory.  These  cases  pre- 
sent  facts,  which  after  all  are  necessary  upon  which  to  found  correct  theory. 
I  do  not  pretend  to  discuss  the  question  of  the  exact  difierence  between  yellow 
and  bilious  fever.  I  will  merely  reiterate  that  as  far  as  my  experience  goes, 
The  peculiar  distinctive  characteristic  of  yelloiv  fever,  is  a  total  absence  of 
biliary  secretion  and  excretion. 


322  Joslin  on  Paralysis  of  the  Face.  [Oct. 


Art.  VIII. — Paralysis  of  the  Face,  successfully  treated  with  Strychnine, 
By  B.  F.  Joslin,  M.D.,  of  the  city  of  New  York. 

I  HAVE  employed  Strychnine  in  two  cases  of  paralysis  of  the  muscles, 
supplied  by  the  portio  dura,  called  by  Bell  the  respiratory  nerve  of  the  face. 
Though  this  affection  does  not  endanger  life,  it  is  extremely  inconvenient, 
and  occasions  great  deformity.  One  of  these  cases  differed  in  some  respects 
from  any  which  I  have  met  with  in  books.  It  was  an  uncomplicated  paraly- 
sis of  the  portio  dura  on  both  sides.  In  the  numerous  cases  given  in  the 
appendix  to  Sir  Charles  Bell's  elaborate  work  on  the  nerves,  there  is  but 
one  case  of  paralysis  of  both  sides  of  the  face,  and  in  that  the  affection  of 
the  portio  dura  was  complicated  with  that  of  other  nerves.  Paralysis  on  one 
side  of  the  face  has  been  frequently  observed;  and  although  many  cases 
have  yielded  to  depletion,  counter-irritation  or  mercury,  others  have  obsti- 
nately resisted  these  older  remedies.  Strychnine  has  of  late  been  employed 
with  advantage;  but  the  modes  and  laws  of  its  action  seem  to  have  been  but 
imperfectly  investigated.  The  following  cases  may  contribute  something  to 
the  stock  of  observations  necessary  to  elucidate  these  subjects,  whilst  at  the 
same  time  they  corroborate  the  physiological  doctrines  of  Bell,  in  regard  to  the 
functions  of  this  nerve,  as  having  no  influence  in  sensation  and  as  being  the 
common  source  of  power  to  all  the  muscles  of  expression,  whilst  the 
branches  of  the  fifth  pair  supply  the  muscles  of  mastication,  and  confer 
common  sensibility. 

Case  I. — Paralysis  of  both  sides  of  the  face, — £^pril  I7th,  1840. — A 
young  man,  W.  H.  L.,  had  been  for  the  last  four  days  unable  to  shut  his 
mouth,  except  by  means  of  his  fingers,  or  by  the  impulse  of  the  air  against 
them  during  a  forced  inspiration.  This  was  the  defect  which  appeared  to 
give  him  most  concern,  as  it  affected  his  speech.  Of  course,  he  could  arti- 
culate no  words  containing  labial  letters.  From  this  circumstance,  and  the 
expression — or  rather  total  want  of  expression — of  his  face,  I  immediately 
perceived  that  there  was  a  paralysis  of  all  the  muscles  of  the  face  which 
were  supplied  by  the  portio  dura.  Those  supplied  exchisively  by  other 
nerves  were  wholly  unaffected.  He  had  perfect  control  of  the  tongue  and 
of  the  masseter,  temporal  and  other  muscles  specially  appropriated  to  masti- 
cation. Still  one  difficulty  existed  in  this  operation,  viz.  an  inability  to  keep 
the  food  properly  between  the  teeth.  This  was  to  be  anticipated,  inasmuch 
as  the  buccinator,  employed  in  this  office,  is  also  connected  with  the  func- 
tion of  respiration.  The  patient  was  wholly  incapable  of  smiling  or  frown- 
ing, or  closing  the  eyelids,  from  paralysis  of  the  zygomatici,  corrugator 
supercilii,  orbicularis  palpebrarum,  &;c.  When  I  requested  him  to  close  his 
eyes,  the  lower  lid  did  not  rise  at  all,  but  the  eyeball  rolled  extensively  up- 


1842.]  Joslin  on  Paralysis  of  the  Face.  323 

ward  under  the  upper  lid,  which  descended  a  litde,  when  I  requested  him 
to  direct  the  eyes  steadily  toward  me.  Whilst  attempting  to  shut  them,  he 
found  it  impossible  to  cover  the  cornea. 

As  the  paralysis  affected  both  sides  of  the  face,  but  did  not  extend  beyond 
it,  I  inferred  that  the  disease  liad  originated  neither  at  the  origin  nor  in  the 
course  of  the  nerve,  but  at  its  organic  extremities,  and  probably  in  conse- 
quence of  an  application  of  lead  to  the  mouth.  The  patient's  answer  to  an 
inquiry  on  this  point,  tended  to  confirm  this  suspicion.  I  learned  that  he 
was  a  printer,  and  had  been  holding  types  in  his  mouth,  when  at  work  as  a 
compositor.  He  had  formerly  done  so,  but  on  learning  that  printer's  types 
were  poisonous,  had,  until  within  a  short  time  previous,  nearly  discontinued 
the  practice.  He  was  at  this  time  perhaps  more  predisposed  to  the  affection 
in  consequence  of  some  exposure  to  cold  a  few  days  before,  and  of  previous 
general  debility  for  some  months,  induced  partly  by  an  exhausting  hemor- 
rhage from  the  leg. 

Treatment.— k.  cathartic  was  directed,  and  the  application  of  tincture  of 
strychnine  to  the  cuticle  of  the  face — about  one  drachm  of  a  solution  containing 
about  three  grains  of  strychnine,  to  an  ounce  of  alcohol,  was  applied  to  each 
side  three  times  a  day,  and  the  absorption  assisted  by  friction.  This  lotion 
sometimes  produced  a  little  twitching  of  the  muscles,  fifteen  or  twenty  mi- 
nutes after  its  application;  and  under  its  use  the  muscles  of  the  face  com- 
pletely recovered  their  power  in  two  or  two  and  a  half  months.  At  the  end 
of  one  month,  the  application  to  the  left  cheek  was  discontinued,  as  the 
muscles  on  that  side  had  completely  recovered.  On  the  opposite  side,  the 
corrugator  supercilii  and  muscles  of  the  mouth  were  more  benefitted  by  the 
first  month's  treatment,  than  the  orbicularis  palpebrarum.  For  complete  re- 
covery, this  side  required  at  least  twice  as  much  time  as  the  opposite  side  of 
the  face. 

Case  II. — Paralysis  of  one  side  of  the  Face. — Mrs.  H.  aged  about  forty- 
five,  became  suddenly  affected  with  great  distortion  of  the  face,  some  time 
in  March,  1840.  The  paralysis  had  been,  during  three  weeks,  preceded  by 
pains  on  the  same  side  of  the  face,  and,  on  some  previous  occasions,  pain  in 
the  corresponding  ear.  The  patient  was  not  seen  by  me  till  the  28th  of 
May.  There  appeared  to  have  been  no  tendency  to  a  spontaneous  recovery 
of  power  by  the  paralyzed  muscles.  The  sensibility  of  the  parts  had  not 
been  affected. 

Symptoms  and  Pathology. — In  this  case  of  paralysis  of  one  side  of  the 
face  without  loss  of  sensibility,  the  affection,  as  in  the  former  case,  was 
entirely  confined  to  the  muscles  of  expression.  Here  it  involved  only  those 
on  the  right  side  of  the  face.  The  opposite  angle  of  the  mouth  was  drawn 
up,  always  half  an  inch,  frequently  three-fourths  above  that  of  the  affected 
side,  but  to  a  much  greater  distance  in  the  actual  direction  of  the  displace- 
ment, i.  e.,  upwards  and  to  the  left.     The  patient,  on  being  asked  whether 


324  Joslin  on  Paralysis  of  the  Face.  [Oct. 

she  could  close  the  right  eye,  seemed  incapable  of  deciding,  but  made  the 
attempt,  and  then  asked  whether  it  was  shut.  The  reason  of  her  uncertainty- 
was  obvious.  The  pupil  was  turned  up  under  the  upper  lid,  which  was  not 
depressed,  but  left  the  sclerotica  exposed.  This  evinced  paralysis  of  those 
branches  of  the  portio  dura  which  supply  the  muscles  of  the  eyelids,  as  the 
obliquity  of  the  mouth  had  of  those  which  supply  its  muscles.  She  com- 
plained that  the  eye  was  irritable,  and  the  lachrymal  secretion  increased. 
This  was  evidently  a  consequence  of  the  eyeball's  exposure  to  the  air,  and 
another  evidence  of  the  paralysis  of  the  muscles. 

To  test  the  paralysis  of  the  buccinator,  I  requested  the  patient  to  blow. 
During  the  attempt,  the  cheek  of  the  affected  side  was  puifed  out  into  a 
hemispherical  shape,  whilst  the  other  side,  in  which  the  buccinator  retained 
its  activity,  remained  comparatively  flat.  I  find  this  can  be  imitated  by  a 
voluntary  effort.  We  can  cause  one  buccinator  to  resist  the  pressure  of  the 
internal  air,  and  allow  the  other  to  yield  passively  to  the  distending  force. 
When  the  buccinator  is  seen  tense,  this  is  no  evidence  of  its  activity.  On 
the  contrary,  with  a  given  pressure  of  the  air,  the  tension  is  greatest  when 
the  muscular  force  is  reduced  to  nothing;  for  then,  in  consequence  of  the 
dilatation  of  the  cheek,  the  distending  force  acts  upon  the  greatest  surface. 

Effects  of  Strychnine. — On  the  29th  of  May,  1840,  about  two  months 
after  the  attack,  the  treatment  with  strychnine  was  commenced.  The  dis- 
tortion of  the  features  was  great,  and,  according  to  the  representations  of  the 
patient,  there  had  been  no  amendment  during  this  time.  I  directed  the 
internal  administration  in  doses  of  one-sixteenth  of  a  grain,  morning  and 
evening.  The  effect  of  that  taken  on  going  to  bed,  was  manifested  in  a  few 
minutes;  that  in  the  morning  produced  no  sensible  contractions.  It  is  a  fact 
of  some  interest,  that  this  agent  is  not  only  determined  specially  to  the  mus- 
cles, but  the  effect  is  chiefly  manifest  in  the  muscles  of  the  affected  side. 
This  I  had  learned  in  a  previous  case.  But  it  would  be  interesting  to  know 
whether,  in  a  partial  paralysis,  the  healthy  or  unaffected  muscles  of  the 
affected  side  are  more  liable  to  the  influence  of  the  strychnine  than  those  of 
the  opposite  side  of  the  body.  The  facts  of  this  case  favour  the  aflirmative. 
The  action  of  the  medicine  was  manifested  by  a  sense  of  drawing  in  the 
muscles.  This,  during  the  early  part  of  the  treatment,  commenced  simulta- 
neously in  both  wrists,  and  extended  progressively  up  the  arms;  but  on  the 
sound  side  never  so  high  as  the  elbow.  On  the  side  corresponding  to  the 
paralyzed  muscles  of  the  face,  it  extended  at  first  to  the  upper  arm,  still 
later,  i.  e.,  on  subsequent  days,  to  the  neck;  whilst  as  yet  its  influence  on 
the  paralyzed  muscles  was  not  manifested  by  any  sensible  contractions. 
About  the  same  time  at  which  these  commenced  in  the  affected  muscles, 
they  ceased  to  be  reproduced  in  the  healthy  muscles,  which  were  not 
affected  with  spasmodic  contractions  during  the  remainder  of  the  treatment. 
Thus  the  sanative  influence  of  the  agent  seemed  to  approach  by  successive 
steps  toward  the  seat  of  the  disorder,  and  there  to  concentrate  itself,  having 


1842.]  Joslin  on  Paralysis  of  the  Face.  325 

first  quitted  the  healthy  side  of  the  body,  and  then  those  parts  of  the  affected 
side  more  remote  from  the  seat  of  the  affection.  It  never  at  any  time  moved 
the  legs. 

The  external  application  of  strychnine  in  this  case  produced  but  litde 
effect.  The  complaint,  which  had  been  much  relieved  by  a  week's  internal 
use,  was  but  little  relieved  by  a  continuance  of  that,  by  the  external  applica- 
tion, or  by  pustulation  near  the  exit  of  the  portio  dura  with  tartrate  of  anti- 
mony.    It  remained  stationary. 

After  some  suspension  of  treatment,  without  any  spontaneous  amendment, 
the  internal  use  of  strychnine  was  recommenced  in  increased  doses  on  the 
21st  of  July.  One-eighth  of  a  grain  was  administered  at  bed-time.  In 
about  ten  minutes  it  caused  a  transient  action  in  some  of  the  muscles  of  the 
ear.  But  the  most  remarkable  effect  of  this  dose  was  a  sudden  and  power- 
ful contraction  of  the  paralyzed  muscles  of  the  mouth,  thirty-six  hours  after 
the  administration  of  the  medicine.  After  the  transient  contraction  of  some 
litde  muscles  of  the  ear,  there  was  no  sensible  manifestation  of  the  action 
of  the  medicine  for  thirty-six  hours,  i.  e.,  till  half  past  nine  of  the  morning 
of  the  second  day.  But  now  the  patient  was  astonished  to  feel  the  mouth 
suddenly  drawn  far  to  the  right,  and  wondered  whether  a  new  and  perma- 
nent distortion  of  the  face  had  occurred  towards  the  side  opposite  the  former. 
A  transient  distortion  had  indeed  occurred  in  consequence  of  an  action  of  the 
paralyzed  muscles,  so  powerful  as  to  overbalance  that  of  their  healthy  anta- 
gonists. Two  other  similar  doses,  at  intervals  of  two  days,  produced  no 
manifest  contractions. 

The  above  phenomena,  and  some  subsequendy  observed,  suggested  some 
topics  for  investigation;  viz.,  the  length  of  time  during  which  strychnine 
acts;  the  effect  of  a  second  dose  during  this  time;  and  the  most  advantageous 
intervals  between  the  repetitions. 

On  the  evening  of  August  3d,  the  internal  use  of  the  medicine  was 
resumed  in  the  same  doses,  to  be  repeated  after  the  same  intervals.  The 
first  dose  produced  no  manifest  contractions.  In  consequence  of  the  patient's 
mistaking  the  directions,  the  second  dose  was  taken  on  the  very  next  even- 
ing. In  about  fifteen  or  twenty  minutes  it  produced  strong  action  near  the 
posterior  part  of  the  jaw  on  both  sides.  The  sensation  was  represented  as 
resembling  that  painful  sensation  near  the  articulation  of  the  jaw  which 
sometimes  attends  the  act  of  gaping.  About  an  hour  after  taking  the  medi- 
cine, the  patient  having  occasion  to  rise  and  walk  across  the  room,  disco- 
vered that  the  muscles  of  the  feet  and  legs  had  nearly  lost  their  power. 
The  next  day,  however,  she  had  her  usual  strength,  and  it  was  manifest 
that  her  face  had  improved. 

In  order  to  prevent  the  repetition  of  disagreeable  effects,  as  well  as  to 

throw  light  on  the  topics  above  mentioned,  I  directed  the  doses  to  be  now 

repeated  at  intervals  of  four  days.     At  some  time  in  the  night  succeeding  the 

expiration  of  two  days  after  the  next  dose,  the  patient  experienced  for  about 

No.  VIII.— October,  1842.  28 


3£6  Joslin  on  Paralysis  of  the  Face.  [Oct 

five  minutes  a  strong  and  peculiar  cracking  sensation  of  the  affected  side  of 
the  face.  She  described  it  as  resembling  that  which  might  attend  a  sud- 
den separation  of  the  parts  in  a  straight  and  vertical  line  extending  from  the 
temple  to  the  base  of  the  jaw.  On  the  next  morning,  the  affected  side  of 
the  face  was  considerably  (Edematous.  Suspecting  this  might  be  in  part  the 
result  of  the  medicine,  I  determined  on  a  reduction  of  the  dose  to  one-six- 
teenth of  a  grain,  still  preserving  the  interval  of  four  days.  The  first  pill 
was  detained  in  the  throat,  and  was  partly  dissolved  by  the  saliva  before  the 
deglutition  was  completed.  It  acted  within  two  or  three  minutes.  The 
sensation  was  represented  to  be  in  part  that  of  a  kind  of  crepitation,  almost 
wholly  confined  to  the  affected  side  of  the  head,  and  comprehending  the  ears, 
face  and  scalp  to  a  considerable  extent.  Having  occasion  to  rise  to  attend 
to  an  infant  an  hour  and  a  half  after  taking  this  small  dose,  the  patient  found 
her  legs  quite  weak.  Next  day,  however,  she  felt  better  than  usual.  The 
patient  after  taking  two  more  doses  of  this  size,  one  every  fourth  evening 
at  bed-time,  left  town  on  the  21st  of  August.  Each  dose  produced  within 
a  few  minutes,  contractions  of  the  muscles  on  the  affected  side  of  the  face, 
but  none  on  the  following  days.  There  was  a  gradual  amendment.  The 
eye  at  that  time  could  be  almost  perfectly  closed.  This  restoration  of  the 
power  of  the  orbicularis  muscle  had  been  followed  by  the  removal  of  that 
irritability  of  the  eyeball  v^hich  had  been  occasioned  by  its  exposure.  The 
deformity  of  the  mouth  had  been  nearly  removed.  The  buccinator  had  been 
less  affected  by  the  medicine  than  the  other  paralyzed  muscles,  and  its 
action,  though  improved,  was  still  defective  The  treatment  with  strychnine 
had  been  employed  about  two  months,  exclusive  of  one  month's  intermis- 
sion. The  patient  carried  with  her  two  dozen  strychnine  pills,  yL  grain 
each,  with  the  use  of  which  the  cure  was  rendered  complete. 

Remarks  on  cases  compared. — It  may  tend  to  throw  some  light  on  the 
mode  of  action  of  the  above  remedy,  to  state  some  coincidences  observed  in 
the  above  cases,  and  in  one  of  hemiplegia  treated  for  a  short  time,  but  with 
less  success,  during  the  same  year.  Here  the  disease  affected  the  portio 
dura  in  common  with  other  nerves,  and  appeared  to  be  peculiarly  sensitive 
to  the  therapeutic  agency  of  strychnine;  and  the  improvement  produced  by 
it  in  the  functions  of  this  nerve  remained  for  months  after  the  discontinuance 
of  the  remedy,  and  when  the  limbs,  which  had  received  less  even  of  tempo- 
rary benefit,  had  totally  relapsed  into  their  former  helplessness.  The  tran- 
sient effect  of  the  medicine  occurred  in  from  half  an  hour  to  an  hour,  but 
on  some  occasions  spontaneously  recurred  about  nine  o'clock  on  the  follow- 
ing morning,  and  at  others,  about  nine  o'clock  on  the  morning  of  the  second 
day,  (i.  e.,  in  thirty-six  hours  after  the  administration,)  but  never  at  other 
hours.  Thus  there  is  a  curious  coincidence  as  to  hour  of  day  and  interval 
in  this  as  compared  with  one  of  the  above  cases.  Can  there  be  any  special 
tendency  in  the  action  of  this  agent  to  recur  at  nine  o'clock  in  the  morning, 


1842.]  Joslin  on  Paralysis  of  the  Face,  327 

or  after  twelve  or  thirty-six  hours  after  its  administration,  and  is  its  primary 
action  more  manifest  in  the  evening? 

That  the  respiratory  muscles  were  influenced  by  the  medicine,  was  shown 
by  an  involuntary  cough,  and  a  sneezing  which  generally  occurred  simulta- 
neously with  the  spasmodic  contraction  of  the  muscles  of  the  extremities. 
These  last  acted  chiefly  on  the  affected  side. 

It  is  possible  that  some  light  may  be  thrown  on  the  subject  of  the  appa- 
rent special  determination  of  the  action  of  strychnine  to  afl'ected  muscles,  by 
some  facts  noticed  in  this  case.  When  the  spasmodic  action  came  on, 
whilst  the  patient  was  sitting  in  his  chair,  with  his  arm  but  slightly  flexed, 
and  his  leg  much  more  flexed,  he  noticed  that  at  the  instant  of  the  spasmo- 
dic action,  the  forearm  always  became  flexed  and  the  leg  extended,  the  latter 
more  powerfully.  Why  this  special  influence  on  the  extensors  of  one  limb 
and  the  flexors  of  the  other?  It  will  be  perceived  that  the  action,  both  in 
direction  and  intensity,  had  some  relation  to  the  previous  position;  and  it 
was  subsequently  ascertained,  that  whether  the  action  in  either  limb  was 
flexion  or  extension,  depended  on  its  previous  position.  If  much  flexed,  it 
became  extended,  if  extended,  flexed.  Should  the  same  results  be  observed 
in  other  patients,  it  might,  perhaps,  enable  us  to  advance  one  more  step  in 
the  explanation  or  generalization  of  the  special  influence  on  paralyzed  mus- 
cles. The  spasmodic  contractions  are  more  readily  excited  in  muscles 
relaxed  by  paralysis  than  in  those  which  are  in  the  normal  condition.  If 
this  special  determination  of  action  is  due  chiefly  to  previous  relaxation,  we 
might  expect  it  to  be  oftener  manifested  in  the  more  relaxed  than  in  the 
more  tense  condition  of  the  muscles,  whether  this  relaxation  had  originated 
in  paralysis,  position  or  volition. 

It  may  be  proper  to  state  some  experiments  made  on  this  patient  which 
were  suggested  by  accident,  and  which  have  a  bearing  on  some  interesting 
points  of  the  theory  of  muscular  action,  if  not  upon  those  points  of  it  involved 
in  the  above  discussion. 

The  experiments  were  suggested  during  the  application  of  powdered 
strychnine  to  a  portion  of  the  instep,  from  which  the  cuticle  had  been 
removed.  But  I  will  first  take  this  occasion  to  state,  that  as  a  therapeutic 
experiment,  it  was  unsuccessful.  Though  the  application  was  made  rather 
freely  to  the  dermis  of  the  anterior  part  of  the  ankle  and  of  the  top  of  the 
foot  denuded  by  successive  epispastics,  there  was  no  appreciable  effect;  and  I 
was  induced  to  suspect  the  endermic  method  to  be  inferior  both  to  the  inter- 
nal use  and  to  the  cuticular  application  which  some  have  denominated  the 
intraleptic  method. 

On  a  certain  day,  as  I  was  pouring  from  a  paper  the  powdered  strychnine 
upon  the  anterior  and  upper  part  of  the  foot,  the  paper  came  accidentally  in 
contact  with  the  sensitive  surface  of  the  blistered  part,  whose  sensibility  like 
that  of  every  other  part  had  been  unafl^ected  by  the  disease.  The  muscles 
of  the  limb,  over  which  neither  the  action  of  the  powder  nor  the  volition  of 


328  '  Nott  on  Lithotomy.  [Oct 

the  patient  had  been  for  sonfe  time  able  to  exercise  the  slightest  control, 
were  Instantly  called  into  forcible  action  by  the  first  contact  of  the  edge  of 
the  paper.  The  foot  was  thrown  upwards,  chiefly  by  the  extensors  of  the 
leg.     The  paper  was  kicked  and  its  contents  scattered. 

The  potency  of  mechanical  irritation  is  of  much  less  interest  than  the 
direction  of  the  motion.  On  this  subject  I  made  repeated  experiments  on 
two  opposite  portions  of  the  surface  of  the  foot,  which  always  resulted  in 
producing  a  motion  towards  the  irritated  part,  a  motion  chiefly  due  to  the 
extensors  and  flexors  of  the  leg  situated  on  the  thigh,  and  of  course  at  a 
great  distance  from  the  part  directly  irritated.  Although  the  patient  was 
incapable  of  moving  the  foot  by  a  voluntary  eflbrt,  it  was  invariably  and 
involuntarily  thrown  upward  by  mechanical  irritation  applied  to  the  vesi- 
cated surface  on  the  upper  side,  and  as  invariably  drawn  downwards  and 
backwards  by  titillation  of  the  sole  or  plantar  region.  Thus,  irritation  of 
the  surface  opposite  one  of  the  extensors  of  the  toes,  the  extensor  brevis 
digitorum  pedis,  called  into  action  the  extensors  of  the  leg,  whilst  irritation 
of  the  surface  opposite  one  of  the  flexors  of  the  toes,  the  flexor  brevis  digi- 
torum pedis,  called  into  action  the  flexors  of  the  leg. 

New  York,  August  12th,  1842. 


Art.  IX. — Remarks  on  the  propriety  and  best  manner  of  breaking  and 
extracting  large  Calculi  in  the  lateral  operation. — By  Josiah  C.  Nott, 
M.D.,  of  Mobile. 

My  object  is  to  prove: 

1st,  That  where  the  calculus  is  large,  and  requires  a  force  in  extraction 
which  would  bruise  and  lacerate  the  soft  parts  severely,  it  is  safer  to  crush  and 
extract  it  piecemeal,  provided  this  can  be  done  without  injury  to  the  bladder. 

2d,  To  recommend,  as  meeting  these  indications,  an  instrument  of  larger 
size,  but  made  after  the  model  of  Heurteloup's  lithotrity  instrument,  brise 
coque  (stone  breaker). 

Most  surgebns  are  familiar  with  the  construction  and  manner  of  using 
Heurteloup's  brise  coque,  and  a  detailed  description  is  not  necessary.  It  is 
composed  of  two  slender  pieces  about  a  foot  long;  one  of  them  slides  up  or 
down  in  a  groove  cut  into  the  other;  when  introduced  into  the  bladder,  its 
extremity  which  is  curved,  is  made  to  open  and  grasp  the  stone  like  the  bill  of 
a  duck;  the  crushing  force  is  then  applied  at  the  other  end  by  the  screw  or 
vis  de  pression  of  Leroy  d'Etiole;  the  force  which  can  be  applied  in  this 
way  (as  Mr.  Velpeau  says)  is  almost  incalculable,  and  no  calculus,  however 
hard,  can  resist  it.  Qne  half  hour's  practice  too,  will  enable  a  novice  to  grasp 


1842.]  Nott  on  Lithotomy,  329 

a  stone  with  more  facility,  and  with  less  risk  to  the  bladder,  with  this  instru- 
ment, than  with  the  common  lithotomy  forceps. 

I  have  in  the  last  three  years  met  with  four  calculi  which  were  so  large, 
that  I  thought  it  most  prudent  to  break  them,  and  used  the  brise  coque  (the 
largest  size  used  in  lithotrity)  with  the  most  satisfactory  results.  Three  of 
them  recovered  without  a  bad  symptom,  and  the  fourth  died  from  pleurisy 
taken  while  convalescing  from  getting  wet  in  a  rain;  none  of  them  had  any 
inflammatory  symptoms  of  the  bladder. 

I  have  recommended  above  an  instrument  of  larger  size,  because  I  know 
that  calculi  do  occur,  which  would  require  a  stronger  instrument  than  those 
used  in  lithotrity.  One  might  be  made  of  double  or  treble  the  ordinary  size, 
and  still  its  construction  is  such  that  the  size  would  be  no  inconvenience> 
when  introduced  through  the  wound  in  the  lateral  operation.  I  have  not 
yet  had  one  made,  because  I  have  rko  maker  at  hand. 

Case  I. — John  Knight,  aetat.  24,  engineer  of  a  steamboat,  had  symptoms 
of  stone  from  childhood;  his  whole  life  had  been  one  of  suffering;  looked 
like  a  man  of  40;  general  health  very  bad,  pulse  very  irritable,  and  in  short 
all  the  circumstances  made  the  case  an  extremely  unpromising  one.  After 
two  weeks  preparation,  on  7th  of  February,  1839,  in  presence  of  several 
medical  friends,  and  with  the  assistance  of  Dr.  R.  Lee  Fearn,  I  performed 
the  lateral  operation  as  described  by  Sir  A.  Cooper;  the  gorget  was  used. 
After  the  bladder  was  laid  open,  I  found  a  stone  as  large  as  a  small  orange, 
and  the  bladder  contracted  firmly  upon  it.  The  exterior  of  the  stone  was 
soft,  crumbled  when  attempts  were  made  to  grasp  it,  and  it  slipped  from  the 
forceps.  These  difficulties  combined  to  foil  all  efforts  at  extraction,  and  a 
good  deal  of  time  was  lost,  to  no  purpose. 

At  length  the  brise  coque  of  Heurteloup  occurred  to  me.  I  introduced  it 
through  the  wound,  seized  the  stone,  and  with  the  assistance  of  the  vis  de 
pression,  crushed  it  instantly;  the  fragments  were  extracted,  the  bladder 
washed  out,  and  the  patient  put  to  bed  without  any  dressing.  The  opera- 
tion was  necessarily  tedious,  but  no  bad  symptom  whatever  occurred;  for 
the  first  two  days,  a  gum  catheter  was  passed  into  the  bladder  night  and 
morning,  while  the  patient  was  sitting  on  a  pot  de  chambre,  and  several  sy- 
ringes of  warm  water  injected  through  the  catheter,  and  made  to  pass  freely 
through  the  wound  so  as  to  wash  out  any  small  fragments  which  might  be 
remaining  in  the  bladder;  (this  I  think  an  important  direction  in  similar 
cases).  The  patient  was  walking  over  town  in  twenty  days  perfectly  well. 
He  has,  since  the  operation,  gained  fifty  pounds,  and  is  now  pursuing  his 
old  occupation  on  the  mail  boat  between  this  and  Blakely. 

Case  II. — About  two  months  after  the  above  case,  I  assisted  my  friend  Dr. 
H.  S.  Levert  in  a  case  very  similar  in  every  respect.  The  patient  was  a  negro 
man  of  about  20  years  of  age,  from  the  interior  of  this  state;  when  the  bladder 

28*    . 


330  Nott  on  Lithotomy.  [Oct. 

was  opened,  a  stone  was  found  about  as  large  as  a  middle-sized  lemon;  and 
the  bladder  firmly  contracted  upon  it;  this  contraction,  as  in  the  other  case, 
remained  during  the  ivhole  operation.  The  same  difficulty  in  extracting 
the  stone  also  occurred.  I  suggested  the  use  of  the  brise  coque,  which  soon 
overcame  the  difficulty.  No  bad  symptom  occurred,  and  the  patient  did 
well. 

The  details  of  the  other  cases  are  unimportant,  and  are  therefore  with- 
held. 

In  the  two  detailed  above,  the  large  size  of  the  calculi;  the  irritable  state 
of  the  bladder;  its  extraordinary  and  continued  contraction;  the  constitutional 
derangement,  (in  the  first  case  particularly,)  &c.,  I  think  rendered  it  impos- 
sible to  extract  safely,  without  crushing;  and  the  large,  clumsy  instruments 
commonly  recommended  by  surgeons  for  this  purpose,  could  not  have  been 
employed,  without  serious  danger  to  the  bladder. 

Sir  Astley  Cooper  says:  "  »^  number  of  calculi  render  the  operation  more 
tedious,  but  not  so  dangerous  as  one  large  stone.  It  is  not  the  number 
of  times  that  the  forceps  are  introduced,  but  the  violence  used  with  them 
which  endangers  the  palient;^^  and  this  opinion  is  one  generally  received  by 
the  profession. 

Sir  A.  Cooper,  Dupuytren,  Boyer,  Lisfranc,  Liston,  Physick,  Gibson, 
Dudley,  Mott,  and  other  leading  authorities  agree  that  the  danger  of  this 
operation  increases  with  the  size  of  the  stone. 

Most  of  these  authorities  advocate  the  enlargement  of  the  wound  by  in- 
cision, where  there  is  difficulty  in  extraction.  Others,  and  particularly  Pro- 
fessor Dudley  of  Kentucky,  advise  us  to  avoid  cutting  as  much  as  possible, 
and  to  depend  upon  gradual  and  forcible  dilatation  and  laceration. 

The  dangers  of  too  much  cutting,  are  hemorrhage,  infiltration,  &c.  The 
dangers  from  contusion  and  laceration  are  inflammation,  sloughing,  infiltra- 
tion, &;c.  (fee. 

If  then  there  be  more  danger  from  one  large  than  many  small  stones;  if 
there  be  danger  from  enlarging  the  wound,  either  by  the  knife  or  by  laceration; 
why,  it  may  be  asked,  is  not  crushing  the  stone  more  frequently  resorted  to? 
The  only  valid  answer  I  can  see  to  this  question  is,  that  the  instruments 
which  are  usually  recommended  for  this  purpose  are  so  massive,  illy-contrived, 
and  difficult  of  application  as  to  endanger  the  bladder,  and  other  soft  parts. 

The  instrument  I  recommend  should  enter  into  every  lithotomy  case  of 
instruments,  for  the  operator  cannot  tell  how  soon  he  may  have  use  for  it;  his 
first  case  may  be  one  of  this  kind.  In  the  case  of  John  Knight,  what  would 
have  been  my  position  had  I  not  fortunately  been  in  possession  of  the  brise 
coque  and  familiar  with  its  use?  I  am  satisfied  my  patient  would  have  lost 
his  life. 

Imagine  a  young  surgeon  with  a  case  to  operate  on.  In  order  to  prepare 
himself,  he  looks  over  his  library — say,  Astley  Cooper,  Dorsey,  Gibson, 
Cooper's  Surgical  Dictionary,  Liston,  &c.  the  books  in  common  use;  he  cuts 


1842.]  '^Qii  on  Lithotomy,  331 

into  the  bladder,  and  finds  a  large  stone — all  of  his  books  have  spoken  of 
large  stones,  but  none  of  them  have  pointed  out  a  way  "  sure  and  safe"  to 
overcome  the  difficulty.  He  seizes  it,  and  pulls  it  away  by  main  force,  either 
with  or  without  additional  cutting,  and  the  patient  dies  from  the  injury  done. 
The  instrument  I  recommend  would  have  enabled  him  to  avoid  the  diffi- 
culty. 

Professor  Dudley  of  Kentucky  has  no  superior,  perhaps  no  equal,  as  a 
lithotomist,  and  there  is  no  one  who  takes  more  pleasure  in  measuring  out 
full  justice  to  him  than  myself.  It  is  stated,  in  a  p*mphlet  of  his  friend  and 
colleague  Dr.  Bush,  which  I  now  have  before  me,  that  he  has  lost  but  four 
patients  out  of  153  operated  on;  and  these  four  died  from  diseases  of  other 
organs. 

This  extraordinary  success  could  not  have  been  attained,  without  extraor- 
dinary skill  in  preparing,  and  in  operating  on  his  patients.  Yet  who  can 
believe,  (not  Professor  Dudley  himself,)  that  his  success  would  have  been  so 
great,  had  his  lot  been  cast  in  the  impure  air  of  London  or  Paris,  instead  of  the 
delightful  little  town  of  Lexington,  which  is  surrounded  by  one  of  the  finest 
countries  in  the  world,  abounding  in  provisions  of  the  best  quality,  and  popu- 
lated by  a  robust  and  hardy  people. 

It  should  be  remembered  that  Dupuytren  saved,  by  the  bilateral  operation 
in  the  foul  air  of  the  Hotel  Dieu,  (the  largest  hospital  iji  Paris,)  twenty-six 
patients  in  succession;  a  success  perhaps,  even  more  astonishing  than  that 
of  Professor  Dudley,  when  all  the  circumstances  are  considered. 

Professor  Dudley,  as  far  as  I  know,  has  never  broken  a  stone,  and  this 
fact  may  be  brought  i?p  as  an  argument  against  me.  I  have  details  of  but 
very  few  of  his  cases,  and  cannot,  therefore,  criticise  them.  I  will,  how- 
ever, make  an  extract  from  the  case  of  Steele,  a  youth  of  17,  which  I  think 
is  strongly  in  my  favour. 

Professor  Dudley  says  "  after  great  labour  and  difficulty,  a  calculus  mea- 
suring about  eleven  inches  in  circumference,  and  upwards  of  three  inches  in 
diameter,  weighing  nine  ounces,  was  extracted.  The  violence  done  the  soft 
parts  by  the  forceps,  the  lever,  and  the  calculus,  caused  the  ivhole  of  the  ac- 
celerator muscles  and  the  bulbous  portion  of  the  urethra  to  slough  and  come 
away,  and  the  bladder,  which  was  filled  by  the  calculus,  except  between  the  en- 
trance of  the  ureters  and  the  prostate,  being  much  lacerated  by  the  various 
efforts  made  to  force  the  legs  of  the  forceps  within  the  cavity  for  the  purpose 
of  seizing  the  stone,  suffered  extensive  infiltration,  followed  by  inflammation 
and  sloughing  of  the  cellular  substance  within  the  cavity  of  the  pelvis,"  &c.  &c. 

Now  strange  as  it  may  appear,  this  patient  under  the  superior  skill  of  Dr. 
D.  recovered!  Would  not  most  patients  under  such  circumstances  have  died, 
and  in  the  foul  air  of  a  city  hospital  would  not  a  recovery  be  a  miracle? 

Would  not  any  surgeon  say  that  it  would  be  better  in  such  cases  to  crush 
the  stone,  if  it  can  be  done  with  facility? 

During  six  years  attendance  on  the  hospitals  of  New  York,  Philadelphia, 


332  Horner  on  Aneurism  of  the  Femoral  Artery,^  [Oct. 

and  Paris,  I  saw  a  good  many  operations  for  stone;  and  I  noticed  that  a 
much  larger  proportion  died  after  the  extraction  of  large  than  small  calculi; 
in  Paris,  particularly,  whenever  I  saw  a  surgeon  exerting  much  force,  I  ex- 
pected sooM  to  hear  of  the  patient's  death. 

It  is  a  fixed  rule  in  surgery,  and  one  which  applies  with  much  stronger 
force  in  large  cities  and  hospitals,  "  that  all  sources  of  irritation  should  be 
avoided  as  much  as  possible." 

Those  of  us  who  practise  in  the  smaller  towns  are  often  astonished  at  our 
own  success;  we  frequ^dy  see  limbs  saved,  which  are  condemned  by  all 
authorities;  and  patients  recover  after  capital  operations,  where  death  would 
seem  almost  certain. 

Note. — When  this  paper  was  put  into  the  editor's  hands,  he  called  my 
attention  to  a  case  published  in  this  Journal  two  years  ago,  by  Dr.  Betton, 
in  which  an  instrument  made  by  Weiss  of  London,  on  the  plan  I  propose, 
(in  other  words  after  Heurteloup's  brise  piere)  was  used  in  the  lateral  ope- 
ration. 

I  am  glad  to  hear  that  other  heads  are  at  work  on  the  same  subject,  as  I 
attach  little  importance  to  originality  in  these  matters.  He  who  successfully 
contributes  towards  the  establishment  of  a  neglected  truth,  deserves  well  of 
the  profession.  I  know  that  Velpeau  in  his  Medicine  Operatoire  states  that 
all  the  lithotrity  instruments  have  been  advised  in  the  lateral  operation.  If, 
however,  our  American  and  English  works  on  surgery  be  examined,  they 
will,  I  am  sure,  be  found  very  deficient  on  the  management  of  large  calcuh. 
Dr.  Betton's  case  was  an  unfortunate  one,  (unavoidably  so,)  and  therefore  not 
calculated  to  draw  attention  to  this  instrument;  my  cases  were  successful, 
and  show  that  tlie  instrument  is  a  useful  one. 


Art.  X. — Aneurism  of  the  Femoral  Artery,  shoiving  the  importance 
of  applying  a  ligature  below,  as  ivell  as  above  the  Sac.  By  Wm.  E. 
Horner,  M.D.,  Professor  of  Anatomy  in  the  University  of  Pennsyl- 
vania, Surgeon  at  the  Philadelphia  Hospital,  &:c. 

In  the  number  of  this  Journal  for  January  1841,  I  related  two  cases  of 
Varicose  Aneurism,  in  which  the  necessity  of  a  ligature  above  the  sac,  and 
of  another  below  it,  was  proved.  I  have  now  to  detail  a  similar  exigency  in 
simple  ttwewrism,  and  which  will  suggest  the  value  of  reconsidering  the  pre- 
sent rules  of  treating  that  disease. 

Isaac  Davis,  a  coloured  man,  a  carpenter,  aged  48,  of  a  constitution  appa- 
rently worn,  though  he  says  that  his  life  has  been  temperate,  regular,  and 
industrious,  came  into  the  Blockley  Hospital  on  the  6th  July  1838,  with  a 


1842.]  Horner  on  Aneurism  of  the  Femoral  Artery,  333 

tumour  the  size  of  the  fist,  in  the  right  inguinal  region,  extending  itself  out- 
wards. It  is  hard,  resisting,  diminishes  but  little  on  pressure,  has  an  aneurismal 
thrill  at  the  inner  side  of  it,  and  when  a  stethoscope  is  applied,  the  rushing 
tumultuous  noise  of  a  fluid  in  violent  agitation  is  easily  perceived.  Pressure 
upon  the  femoral  artery,  below  Poupart's  ligament,  arrests  the  pulsation, 
the  thrill,  and  the  noise.  He  suffers  extreme  pain  in  the  part,  with  numb- 
ness of  the  limb  and  foot,  which  are  somewhat  anasarcous.  He  first  perceived 
the  tumour  eleven  weeks  before,  shortly  after  a  strain  in  handling  a  piece  of 
scantling;  it  was  then  the  size  of  the  last  joint  of  the  thumb,  and  pulsated 
violently;  it  has  grown  constantly  since,  and  according  to  his  account,  the 
pulsation  is  most  distinct  in  the  early  forenoon,  the  tumour  being  then  also 
larger  than  in  the  afternoon.  Since  his  introduction  into  the  ward,  it  has 
evidently  grown  daily,  and  the  pulsation,  from  being  obscure  to  the  feel  at 
first,  has  become  distinct  and  satisfactory. 

He  entered  the  house  anxious  for  an  operation,  his  mind  having  got  its 
tone  from  the  practitioner  who  previously  attended  him.  The  proximity  of 
the  tumour  to  Poupart's  ligament,  with  which  it  was  immediately  in  contact 
and  seemed  to  lift  up,  together  with  my  doubts  on  the  state  of  the  artery 
above,  disinclined  me  strongly  to  an  operation;  the  solicitation  of  the  patient, 
however,  prevailed  with  me  on  the  14th  inst.,  and  I  accordingly  undertook 
the  operation  on  the  17th  of  July,  at  12  o'clock,  by  the  consent  and  in  the 
presence  of  the  surgeons  Drs.  Harlan  and  Pancoast,  who  assisted  me  mate- 
rially in  the  progress  of  it.  There  were  several  younger  surgeons  present, 
not  of  the  house,  the  students  of  the  house,  and  Dr.  Gerhard  with  his  cli- 
nical class. 

The  first  act  of  the  operation  was  to  cut  through  the  skin  in  a  line  of  four 
inches  length,  nearly  parallel  with  Poupart's  ligament,  the  upper  end  of  the 
line  somewhat  above  Poupart's  ligament;  an  incision  was  then  made  also 
through  the  skin  from  the  first  over  the  course  of  the  femoral  artery  along 
the  inner  side  of  the  tumour  for  two  inches.  The  fascia  superficialis  was 
cut  through  in  the  same  lines.  Poupart's  ligament  was  then  detached  from 
the  fascia  lata  femoris,  the  inferior  edge  of  the  internal  oblique  and  of  the 
transversalis  were  then  raised  up.  Finding  Poupart's  ligament  very  much 
on  the  stretch,  from  the  pressure  upwards  of  the  tumour,  I  divided  trans- 
versely a  few  of  its  fibres.  I  then  moved  the  peritoneum  and  the  subja- 
cent cellular  substance  aside,  and  having  felt  distincly  the  pulsation  of  the 
external  iliac  artery,  I  passed  about  an  inch  above  Poupart's  ligament,  my 
large  heemostatic  hook  with  its  ligature  around  the  artery  from  within  out- 
wards; in  this  I  was  directed  wholly  by  the  touch,  as  the  parts  were  so  con- 
fined as  to  render  vision  unavailing.  Finding  some  difficulty  in»  slipping 
the  ligature  over  the  point  of  the  hook,  I  loosened  the  handle  and  brought 
out  hook  and  ligature  with  the  aid  of  a  pair  of  plyers.  A  ligature  being 
then  under  the  artery,  I  tried  repeatedly,  by  pressing  the  artery  with  the  liga- 


334  Horner  on  Aneurism  of  the  Femoral  Artery.  [Oct. 

tiire  against  the  end  of  a  finger,  whether  the  pulsation  of  the  artery  below 
the  ligature,  and  of  the  tumour  ceased,  and  found  it  to  do  so;  the  other  sur- 
geons of  the  house  joined  in  the  same  experiment,  as  well  as  Dr.  Johnson, 
one  of  the  surgeons  invited.  The  control  of  the  circulation  of  the  external 
iliac  being  thus  evident,  the  ligature  was  tied,  and  the  pulsation  of  the  aneu- 
rism ceased  instantly. 

Apprehensive  from  what  had  occurred  in  the  case  of  Gen.  P.  to  Dr. 
Harris  and  myself  in  Varicose  Aneurism,  and  with  Dr.  Randolph,  in 
the  same  kind  of  disease,  (see  Am.  Journ.  ut  supra,)  that  there  might 
be  some  supply  of  blood  to  the  sac  besides,  I  determined  to  ascertain  by 
opening  the  tumour,  which  I  did  very  freely,  and  turned  out  of  it  half  a  pint 
of  laminated  fibrin,  and  as  much  fluid  arterial  blood.  The  blood  collected 
with  extreme  rapidity  in  the  sac,  and  we  encountered  almost  immediately  a 
formidable  and  urgent  hemorrhage  from  it,  which  notwithstanding  the  intro- 
duction of  sponges  and  pressure  on  them,  yielded  from  sixteen  to  twenty  or 
more  ounces  of  blood  in  a  few  minutes.  I  was  certainly  not  prepared  in  mind 
for  so  much  bleeding;  the  mode  to  meet,  or  rather  anticipate  it  would  have 
been  to  have  two  tourniquets  on  after  the  artery  was  taken  up,  one  at  Pou- 
part's  ligament,  the  other  below  the  tumour;  and  having  screwed  up  the 
upper  one  to  press  from  the  tumour  all  its  fluid  blood  and  then  to  screw  up 
the  lower  tourniquet;  next  to  open  and  clear  the  sac  of  its  coagulum,  then 
loosen  the  upper  tourniquet  and  take  up  such  vessels  as  bled,  and  do  the  same 
afterwards  with  the  lower  tourniquet.  I  might  have  saved  the  patient  six- 
teen ounces  of  blood,  by  such  precautions. 

Dr.  Harlan  pressed  on  the  femoral  artery  below  the  tumour  with  some 
eflfect;  he  then  proposed  to  confine  the  limb  just  below  the  tumour  with  a 
tourniquet;  this  was  done  instantly;  a  simultaneous  fainting  of  the  patient 
lasting  for  four  or  five  minutes,  was  attended  with  a  diminution  of  the  hemor- 
rhage. 

I  then  laid  open  the  sac  still  more  freely  by  the  previous  crucial  cut  being 
extended,  in  doing  which  the  femoral  artery  at  the  lower  and  inner  side  of 
the  sac  was  cut  through;  ligatures  were  thrown  with  my  haemostatic  hook 
below  and  above  the  cut  through  the  femoral  artery,  by  which  the  bleeding 
was  measurably  reduced,  but  not  suppressed.  I  next  made  a  further  explo- 
ration of  the  sac,  and  found  that  the  femoral  artery  was  bleeding  into  it  from 
above  the  sac.  The  artery  was  next  secured  there  also  by  a  ligature,  with 
my  hook.  The  hemorrhage  upon  this  ceased  entirely,  as  a  careful  examina- 
tion of  the  whole  interior  of  the  sac  exhibited  no  bleeding  orifice:  but  for 
fear  of  the  insuflttciency  of  this  ligature  of  the  femoral  artery,  which  was  put 
on  in  some  haste,  I  placed  still  another  above  it. 

A  process  of  the  sac  was  found  to  have  passed  for  some  inches  upwards 
under  Poupart's  ligament  into  the  abdomen,  it  was  just  within  the  anterior 
superior  spinous  process  of  the  ilium.     This  acounted  for  the  extreme  ten- 


1842.]  "Roxwex  on  Aneurism  of  the  Femoral  Artery,  335 

sion  of  Poupart's  ligament  during  the  operation,  and  the  great  difficulty  I 
had  in  making  space  to  work  the  instrument  for  taking  up  the  external  iliac. 
The  entire  operation  lasted  forty-five  minutes.  An  interval  was  then 
allowed  to  see  whether  all  was  secured,  which  appeared  to  be  the  case.  The 
dressing  was  next  executed.  The  edges  of  the  cuts  were  kept  apart  by  lint, 
that  is  to  say,  the  cut  for  the  iliac  artery  as  well  as  the  cut  into  the  aneu- 
risnial  tumour;  they  were  then  approximated  with  strips  of  sticking  plaster, 
and  fixed  in  place  with  a  compress  and  a  bandage  of  the  figure  of  8.  The 
patient  was  put  to  bed,  and  in  a  little  time  his  circulation  and  vivacity  were 
strong. 

At  this  moment  the  following  questions  arose  in  my  mind.  Where  did 
the  hemorrhage  from  the  sac  come  from?  by  what  routes?  not  the  external 
iliac,  because  we  had  every  evidence  of  that  being  fast?  The  routes  open 
to  this  suspicion  are  the  epigastric  and  circumflex  iliac,  for  the  bleeding  from 
that  end  of  the  femoral  artery  above  the  sac:  and  the  profunda,  for  the  femo- 
ral bleeding  below  the  sac.  The  originally  diseased  portion  of  the  artery  wa.^ 
about  two  inches  long.  The  sac  was  upon  one  side  of  it,  the  iliac,  exclusively 
and  expanded  to  form  a  tumour  as  capacious  as  a  pint  measure. 

As  I  did  not  see  the  profunda,  I  had  no  distinct  conception  of  its  place  of 
origin. 

J^dy  ISth. — Is  in  a  tranquil  good  state  to-day.  The  limb  has  its  natural 
temperature,  (the  weather  is  very  hot,  thermometer  at  80°).  The  pain  which 
was  formerly  in  it  from  the  aneurismal  tumour  is  gone,  and  it  feels  according 
to  his  account,  natural;  a  previously  existing  oedema  of  foot  has  also  sub- 
sided. His  pulse  is  good.  From  some  cause  or  other  he  was  seized 
during  the  night,  with  dyspnoea.  Ordered  a  large  sinapism  to  thorax.  K. 
Acid  tart.  gr.  x.,  Ant.  tart.  gr.  i.,  sulph.  magn.  3vi.,  aq.  ^viii. — M.  5ss.  every 
two  hours. 

I9th. — His  breathing  to-day  is  hurried  and  catarrhal,  as  if  there  were  an 
accumulation  of  mucus  in  bronchia.  His  countenance  has  rather  a  distress- 
ed appearance,  and  though  he  is  perfectly  collected,  he  does  not  seem  quite 
so  well.  His  pulse  last  night,  Mr.  Wendel  the  senior  student  informs  me, 
rose  to  140;  it  is  now  full,  soft,  and  short.  I  ordered  a  blister  plaster  to 
front  of  thorax;  vol.  julap,  §ss.  every  two  hours,  with  a  dose  of  tinct.  of 
lobelia  in  the  same,  according  to  indications. 

The  wound  a  little  sore  to  touch,  says  it  hurts  when  he  coughs. 
20th. — The  patient  had  another  attack  of  difficult  breathing  last  night,  but 
not  so  severe.  Dressed  the  wound;  found  that  it  had  suppurated  somewhat, 
and  that  there  had  been  an  eff'usion  at  its  edges  of  coagulating  lymph.  He 
is  very  much  debilitated,  and  his  breathing  is  high  and  short,  with  occasional 
cough;  limb  generally  easy,  excepting  ankle  and  heel,  which  are  painful;  it 
temperature  natural,  no  pulsation  perceptible  in  pedosal  artery.  Ordered 
mush  and  milk  for  his  diet.     Tinct.  cinchon.  comp.  3i.  every  two  hours. 


336  Corner  on  Aneurism  of  the  Femoral  Artery.  [Oct. 

Bowels  not  having  been  opened  since  the  day  of  operation;  directed  a  des- 
sert spoonful  of  castor  oil  every  two  hours  till  that  was  accomplished. 

2\st. — Oil  produced  five  free  evacuations.  Breathing  not  so  laboured. 
Dr.  Gerhard  having  explored  the  front  of  the  lungs  for  me,  concluded  the 
left  to  be  nearly  sound,  the  other  with  a  slight  mucous  rattle  in  the  cardiac  re- 
gion. Had  a  very  severe  chill  before  I  saw  him;  debility  increased;  voice 
feeble,  countenance  rather  collapsed.  Wound  in  about  the  same  state  as 
yesterday;  very  inconsiderable  suppuration  from  it;  the  aneurism  is  now 
simply  a  fissure  about  capacious  enough  to  lay  the  whole  length  of  the  fore 
finger  in;  great  pain  in  leg  from  knee  to  foot;  temperature  of  limb  good. 

22c/. — Symptoms  of  feebleness  increased;  leg  rather  cold;  wound  flabby, 
inactive,  and  has  merely  secreted  a  little  serum,  with  some  pus;  voice  weak, 
and  made  with  effort.     Has  had  another  chill  this  morning. 

Directed  Sulph.  quinin.  in  solut.  1  gr.  every  hour.  Egg,  milk  and  brandy, 
ad  libitum.  Wound  to  be  dressed  with  a  suppurative  poultice,  made  of 
bread,  milk,  and  basilicon  ointment.  Touched  the  surface  of  it  with  sp. 
camph. 

He  died  this  afternoon  at  4  o'clock.  ' 

Autopsy,  July  23c?,  1 1  o'clock  A.  M.  The  weather  being  still  very 
warm,  some  advance  in  putrefaction,  the  parts  operated  on  were  therefore 
black  and  discoloured  on  their  surface. 

The  external  iliac  was  inflamed  to  a  deep  red  from  the  ligature  to  a  few 
lines  of  its  root,  and  contained  a  loose  thin  coagulum  of  blood  adhering  to 
its  sides.  It  had  been  secured  precisely  at  the  point  intended,  to  wit,  just 
above  the  epigastric,  and  the  ligature  had  been  properly  drawn:  neither  the 
peritoneum,  nor  the  iliac  vein  was  injured.  A  recent  suppuration  in  the 
sub-peritoneal  cellular  substance  was  found  to  start  at  the  ligature,  and  ran 
up  the  iliac  fossa  and  loins  to  terminate  behind  the  right  kidney  where  a  sort 
of  font  was  formed  behind  the  psoas  magnus.  Pressure  by  the  tumour 
upon  the  surrounding  muscles  had  hardened  and  changed  their  structure;  some 
caries  had  occurred  on  the  ilio-pectineal  protuberance  from  that  cause. 
Wishing  to  make  a  more  deliberate  examination,  I  cut  the  parts  out  to  pre- 
pare in  spirits  of  wine.  The  structure  being  cleared  by  this  process,  I  found 
that  an  aneurismal  orifice  of  an  inch  in  length,  existed  on  the  iliac  side  of 
the  femoral  artery,  that  the  sac  itself  was  formed  almost  entirely  by  the  con- 
tiguous cellular  substance  of  the  inguinal  and  iliac  regions,  and  that  the  trunk 
of  the  anterior  crural  nerve  passed  along  the  iliac  margin  of  the  cavity  of 
the  sac  contributing  to  its  surface  interiorly.*  The  profunda  artery  arose  at 
or  near  the  aneurismal  orifice;  the  precise  point  I  did  not  ascertain,  but  I  be- 
lieve very  close  to  its  upper  end;  we  may  therefore  conclude  that  the  retro- 
grade hemorrhage  came  from  the  anastomosing  of  its  branches  with  those 

*  This  preparation  is  now  in  the  Anatomical  Cabinet  of  the  University  of  Pennsylvania, 
marked  A.  No.  43,  3. 


1842.]  Pancoast's  Plastic  Operations.  337 

of  the  internal  iliac  artery,  and  also  from  the  epigastric  and  circumflex  iliac, 
judgmg  from  the  incidents  of  the  operation. 

Appearances  having  no  immediate  dependence  on  the  disease,  were  a  heart 
hypertrophied  with  some  thickening  of  the  valves  of  the  left  side,  an  enlarge- 
ment of  aorta,  and  a  small  black  vegetation  immediately  below  the  valves 
of  the  aorta.  Two  ounces  of  water  in  pericardium.  Lungs  of  both  sides 
adhered  to  parietes  of  chest  from  an  ancient  pleurisy,  affecting  their  entire 
periphery.     The  lungs  were  somewhat  congested  with  blood. 

The  abdominal  viscera  were  examined  superficially,  and  were  in  good 
order,  with  no  peritoneal  inflammation.  I  observed  however,  an  anomalous 
sac,  such  as  I  had  never  met  with  before;  it  was  a  spherical  pouch  of  peri- 
toneum of  the  capacity  of  a  quart,  situated  in  the  right  iliac  fossa,  under  the 
head  of  the  colon,  which  it  had  lifted  out  of  its  place  almost  into  the  lum- 
bar region.  This  pouch  was  in  fact  an  internal  hernial  sac,  a  pocket  formed 
exclusively  of  peritoneum  like  a  diverticulum  from  this  membrane,  and  con- 
tained the  lower  half  of  the  small  intestinal  canal;  it  resembled  precisely  a 
large  bladder  filled  with  intestines,  having  its  orifice  of  a  reduced  size,  but 
not  so  much  so  as  to  threaten  strangulation.  Its  parietes  were  so  trans- 
parent, that  the  first  impression  was  that  of  an  ancient  peritoneal  adhe- 
sion of  the  small  intestines.  There  was  no  point  in  the  parietes  of  the  ab- 
domen where  this  preternatural  sac  seemed  to  have  at  any  period  protruded, 
it  was,  therefore,  a  pure  peritoneal  hernia  occupying  the  iliac  region,  and  fur^ 
nishing  no  external  indication  of  its  existence. 

In  the  above  narrative,  we  have  a  third  example  occurring  within  the  space 
of  a  year  under  the  observation  of  one  individual,  where  it  was  absolutely 
necessary  to  apply  one  ligature  above  the  aneurism  and  another  below  it,  to 
arrest  the  hemorrhage,  and  this  last  a  case  of  simple  aneurism. 


Art  XI. — Plastic  Operations.     By  J.  Pancoast,  M.  D.,  Professor  of 
Anatomy  in  Jeflferson  Medical  College. 

The  modes  of  restoring  lost  parts  by  plastic  operations  consist,  properly 
speaking,  but  of  two  kinds.  1st.  Where  the  integument  is  brought  from  a 
distant  part.     2d.  Where  it  is  derived  from  the  adjacent  region. 

1st  Mode. — This  comprises  operations  for  the  restoration  of  the  nose  and 
lips  in  which  the  integument  is  brought  from  the  arm  after  the  Italian  or 
Tagliacotian  method,  from  the  forearm  as  was  practised  by  Graefe,  Delpech 
and  Dieffenbach,  or  from  the  back  of  the  hand,  as  has  been  done  by  Roux. 
The  two  latter  modifications  have  been  devised  for  the  purpose  of  rendering 
the  necessary  confinement  of  the  arm  to  the  defective  part  less  painful  and 
fatiguing;  the  flap  in  all  these  cases  being  left  adherent  to  the  arm,  till  union 
No.  VIII.— October,  1842.  29 


338  '  Pancoast's  Plastic  Operations.  [Oct. 

had  taken  place  at  its  other  end  with  the  part  to  which  it  had  been  attached 
by  suture.  In  several  instances,  a  portion  of  integument  has  been  entirely 
removed  from  the  arm  or  thigh,  and  at  once  applied  on  the  surface  of  the 
organ  to  be  restored  which  had  been  previously  freshened  with  the  knife. 

This  method  has  been  completely  successful  in  restoring  small  breaches 
of  surface,  in  the  hands  of  Dr.  John  Mason  Warren,  of  Boston,  and  others, 
though  it  generally  failed  in  the  practice  of  Graefe  and  B linger,  who  fre- 
quently tried  it.  It  is  practised  upon  the  same  grounds,  that  parts  com- 
pletely severed  by  accident  from  the  body,  have  occasionally  been  found 
after  many  minutes,  or  even  half  an  hour  had  elapsed,  and  they  had  become 
perfectly  pale  and  bloodless,  still  to  retain  a  sufficient  degree  of  vitality  to 
accept  of  union  after  nice  adjustment  to  the  part  from  whence  they  had  been 
removed.  This  has  been  successful  in  my  hands  in  one  case  where  the 
lobe  of  the  left  ear  had  been  torn  completely  off. 

2d  Mode. — In  the  plan  of  operating,  in  which  the  flap  is  taken  front 
the  immediate  neighbourhood  of  the  part  to  be  supplied,  there  are  many 
varieties. 

l5^.  Rhinoplasty,  after  the  Indian  method,  where  the  flap  is  taken  from 
the  forehead,  twisted  round  upon  its  pedicle,  so  as  to  be  brought  over  the 
stump  of  the  nose,  to  which  it  is  tastened  by  suture.  This  plan  is  the  most 
approved  in  the, restoration  of  the  nose,  and  has  been  practised  with  success 
by  many  of  the  European  surgeons,  and  several  of  our  own  country. 

26?.  Rotation  of  lamina  ivithout  ttvisting,  A  lamen  of  integument  is 
here  raised,  the  root  or  pedicle  of  which  is  left  attached  at  a  point  adjoining 
the  breach  to  be  filled  up.  An  incision  is  first  made  from  what  is  to  be 
the  outer  side  of  the  pedicle,  circumscribing  the  lamen  so  as  to  give  it  the 
form  desired,  and  terminating  in  the  breach  at  the  opposite  side  of  the  pedi- 
cle. The  flap  is  then  to  be  raised  by  dissection,  rotated  upon  its  pedicle, 
and  fixed  by  suture  to  the  raw  margin  of  the  defective  part.  After  union 
the  pedicle  in  general  does  not  require  to  be  divided.  Liston  has  applied 
this  process  to  the  restoration  of  one  of  the  alee  of  the  nose;  Dieff"enbach 
and  Von  Amnion  to  the  reconstruction  of  the  eyelids;  Jobert  and  Velpeau  to 
the  closure  of  vesico-vaginal  fistulae;  Mutter  to  the  filling  up  of  the  denuded 
surface  left  by  the  division  of  cicatrices,  &c.  &c. 

3.  Simple  sliding  of  the  flap.  Glissement  du  lambeau. — The  flap  to 
be  raised  forms  by  its  free  edge,  one  of  the  margins  of  the  solution  of 
continuity  to  be  filled  up.  It  is  to  be  dissected  back  from  the  breach  suffi- 
ciently far  to  enable  the  operator  to  stretch  it,  without  rotation  or  twisting, 
so  as  to  cover  the  place  upon  which  it  is  to  be  applied.  It  has  been  fre- 
quently employed  in  replacing  lost  portions  of  the  alae  of  the  nose,  and  in 
repairing  deficiencies  of  the  lips  and  eyelids.  It  has  been  a  favourite  method, 
with  the  French  surgeons,  but  is  in  fact  little  more  than  the  old  operation' 
of  Celsus,  who,  in  addition,  practised  a  semicircular  incision  through  the^ 
skin,  at  some  distance  beyond  the  pedicle  of  the  flap,  so  as  to  allow  it  to 
yield  the  more  readily  to  the  traction.   A  modification  of  this  has  been  made 


1842.]  Pancoast's  Plastic  Operations.  ^39 

by  Mr.  T.  Wharton  Jones,  for  shortening  or  ectropion  of  the  upper  eye-lid. 
Two  incisions  are  carried  up  from  near  the  base  of  the  lid,  so  as  to  meet 
at  an  acute  angle  on  the  forehead.  The  apex  of  the  triangle  thus  formed 
is  to  be  raised  by  dissection,  till  the  lid  below  is  so  loosened  as  to  be  sus- 
ceptible of  being  brought  down  to  its  proper  level.  The  raw  surface  above 
left  by  the  sliding  down  of  the  triangle,  is  to  be  closed  by  suture. 

4:th.  By  reflection  of  the  flap.  The  flap  is  to  be  raised  from  a  surface 
near  to  the  point  on  which  it  is  to  be  applied,  and  carried  by  simple  reflec- 
tion to  the  defective  part,  upon  the  margins  of  which  it  is  to  be  affixed  by 
suture.  In  this  way  fissure  through  the  hard  palate,  complicated  with  hare- 
lip, has  been  closed  by  Sanson;  a  flap  being  separated  from  one  margin  of  the 
divided  lip,  and  bent  in  upon  the  fissure.  The  column  of  the  nose  has  been 
restored  by  separating  a  vertical  flap  from  the  whole  thickness  of  the  upper 
lip,  and  reflecting  it  upwards  to  the  apex  of  the  nose;  the  mucous  membrane 
of  the  reflected  flap  becoming  external,  and  gradually  taking  on  the  appear- 
ance of  skin.  Where  the  lip  was  short,  Dieflenbach  has  allowed  the  mucous 
membrane  of  the  lip  to  remain  undivided  for  the  growth  of  granulations. 

bth.  By  demirotation  and  traction.  The  flap  is  to  be  cut  up  some  dis- 
tance above  or  below  the  defective  part,  and  partly  rotated  and  partly  stretched, 
so  as  to  be  made  to  fill  up  the  vacancy.  In  this  way,  deficiencies  of  the 
lips,  lids,  palate,  &c.,  have  been  supplied  by  various  surgeons.  In  some  cases, 
the  flap  consists  of  the  skin  and  subcutaneous  tissue,  sometimes  of  mucous 
membrane  only,  and  sometimes,  as  where  the  entire  lower  lip  is  to  be  sup- 
plied, of  the  whole  thickness  of  the  cheeks. 

Qth.  By  rolling  of  the  flap.  An  elongated  rectangular  portion  of  integu- 
ment is  to  be  cut  up  and  rolled  upon  its  cutaneous  surface  in  order  to  form  a 
plug,  and  then  introduced  so  as  to  make  a  solid  closure  of  openings  which 
are  rounded,  and  not  of  great  size;  the  edges  of  which  having  been  first 
shaved  off".  Velpeau  has  applied  this  plan  to  the  cure  of  fistulas  left  after  the 
operation  of  tracheotomy,  and  in  analogous  cases;  Sanson  and  others  to 
artificial  anus;  Jamieson  to  the  radical  cure  of  hernia  after  operation. 

1th.  By  successive  migration  of  lamina.  This  is  a  modification  of  the 
method  of  Tagliacotius.  A  flap  is  raised  from  a  remote  part,  and  brought 
by  successive  graftings  and  transplantations  to  the  vacancy  to  be  filled  up. 
This  has  been  employed  by  Roux,  in  the  supplying  of  lost  portions  of  the 
cheeks;  the  flap  was  first  taken  from  the  thigh  of  the  patient;  and  in  a  case 
reported  by  Blandin,  where  a  part  of  the  upper  lip,  part  of  the  cheek  and 
ala  of  the  nose  had  been  destroyed,  in  which  a  flap  was  taken  from  the 
lower  lip,  first  attached  to  the  upper  lip,  and  then  transferred  successfully  to 
the  cheek  and  nose.  Prof.  Mutter  and  others  have  also  employed  with  success 
this  plan  of  the  migration  of  lamina.  But  it  has  not  proved  in  my  hands  in 
general  a  satisfactory  process,  as  it  is  attended  with  much  sufl'ering  to  the 
patient,  some  difficulty  on  the  part  of  the  operator,  and  great  liability  to 
failure  from  sphacelation  of  the  retransplanted  flap. 


340^^  Pancoast's  Plastic  Operations.  [Oct. 

8/A.  By  bridge-like  elevation  of  the  flap.  This  consists  in  raising  two 
elongated  flaps  one  on  each  side  of  the  preternatural  orifice;  the  two  ends  of 
each  flap  are  to  be  left  adherent.  The  flaps  are  then  to  be  dissected  under- 
neath, so  that  they  may  be  slid  as  bridges  over  the  opening;  the  proximate 
edges  of  the  flaps  are  then  to  be  fastened  by  suture.  This  plan  has  been 
employed  by  Velpeau  and  others,  to  the  cure  of  fistulae  in  the  cavities  of  the 
mouth,  vagina  and  rectum,  and  by  DiefTenbach  to  the  cure  of  urethral  fistula 
in  the  male.  An  ingenious  modification  of  this  process  has  been  made  by 
Dr.  Mettauer  of  Virginia,  and  has  been  successfully  employed  both  by  him 
and  Professor  Miitter  in  the  closure  of  small  openings  in  the  palate.  It 
consists  simply,  in  addition  to  the  operation  as  above  described,  of  the 
insertion  of  some  soft  substance,  as  a  roll  of  buckskin,  into  the  new  sulcus 
formed  on  each  side  of  the  flaps,  so  as  to  raise  a  growth  of  granulations 
from  its  bottom,  and  sustain  the  flaps  in  their  new  position. 

In  the  above  classification  is  found  displayed  all,  or  nearly  all,  the  prin- 
ciples which  have  been  variously  employed  in  the  cure  of  deformities  by 
plastic  surgery.  It  is  necessary  that  the  operator  should  be  familiar  with 
the  resources  of  this  department  of  the  art,  though  there  can  exist,  in  gene- 
ral, no  prescriptive  plan  of  treatment.  The  deformities  requiring  plastic 
operations  are  necessarily  so  dissimilar  in  different  cases,  that  every  new 
one  becomes  a  separate  subject  of  study  to  the  surgeon,  and  opens  a  fresh 
field  for  the  exercise  of  his  ingenuity  in  restoring  the  lost  or  deformed  parts, 
with  the  best  success  and  the  least  injury  to  the  neighbouring  tissues, 

A  faithful  report  of  cases,  whatever  be  their  results,  which  show  the 
application  of  most  of  these  processes  can  hardly  fail,  therefore,  to  be  read 
with  interest,  by  those  about  to  undertake  the  same  kind  of  operations. 

Case  I.*  Destruction  of  the  hard  palate,  the  septum  narium,  and  the 
soft  parts  of  the  nose  by  scrofulous  ulceration.  Cure  of  the  Deformity 
by  Rhinoplasty — Flaps  taken  from  the  cheeks,  by  what  has  sometimes 
been  called  the  Second  Indian  Method. — James  Hanrahan,  an  intelligent 
Irishman,  about  24  years  of  age,  living,  by  his  own  account,  a  correct  life,  and 
never  having  suffered  from  the  venereal,  was  afflicted  about  three  years  ago, 
with  a  subcutaneous  scrofulous  tubercle  over  the  region  of  the  stomach. 
This  became  livid  on  the  surface,  suppurated,  and  was  about  three  months 
in  getting  well.  Shortly  after  it  healed,  another  of  a  similar  character 
appeared  over  the  sternum.  For  this  he  was  under  treatment  in  the  Penn- 
sylvania Hospital.  The  sternum  became  carious,  and  a  portion  of  it  was 
removed  by  Dr.  Thomas  Harris.  Discharged  from  the  Hospital,  the  dis- 
ease showed  itself  three  months  afterwards  in  the  roof  of  the  mouth  oppo- 
site the  junction  of  the  palatine  processes  of  the  upper  maxillary,  and  the 

*  For  the  notes  of  the  case  I  am  indebted  to  my  friend,  Dr.  Perry,  Ga.,  resident  House- 
Surgeon. 


1842.] 


Pancoast's  Plastic  Operations, 


341 


horizontal  portion  of  the  palate  bones.  Necrosis  of  these  bony  plates  followed; 
the  disease  extended  upwards  along  the  septum  narium,  and  in  about  eight 
months  after  its  appearance  in  the  mouth,  attacked  the  soft  parts  of  the  nose. 
It  was  not  arrested  till  it  had  destroyed  a  great  portion  of  the  hard  palate, 
the  sockets  of  all  the  upper  incisor  teeth,  all  the  cartilaginous  portion  of  the 
septum  narium,  the  inferior  turbinated  bones,  the  whole  of  the  superior 
lateral  cartilages  of  the  nose,  and  a  considerable  part  of  the  inferior  oval 
cartilages  as  well  as  the  integuments  of  the  nose,  leaving  an  open  cavity 
three  quarters  of  an  inch  in  extent,  between  the  ends  of  the  ossa  nasi 
and  the  tip  of  the  nose,  which,  with  the  columna  nasi,  and  the  ante- 
rior margin  of  the  nostrils  were  uninjured.  In  August,  1840,  cicatriza- 
tion of  the  ulcer  took  place;  and  as  this  process  went  on,  the  tip  of  the 
inferior  remnant  of  the  nose  was  drawn  up  for  half  an  inch,  and  at  the  same 
time  sunk  down  nearly  to  a  level  with  the  cheek.  The  destruction  of  the 
alae  having  been  greatest  on  the  left  side,  the  retraction  of  the  margin  of  the 
left  nostril  was  greatest.  In  a  face  which  was  otherwise  well  formed,  an 
excessive  degree  of  deformity  had  been  produced,  from  which  the  patient 
was  desirous  at  any  risk  to  be  freed.     The  accompanying  cut,  (Fig.  1,)  is 

Fig.  1. 


a  faithful  representation  of  the  face  at  the  time  of  the  operation.  The  soft 
palate  was  uninjured.  The  opening  in  the  hard  palate  extended  from  the 
upper  lip  backward  for  an  inch  and  a  quarter,  and  at  its  widest  part,  was 
about  three  quarters  of  an  inch  broad.  The  gums  uniting  across,  had 
formed  a  fleshy  band  in  front  of  this  opening,  and  the  upper  lip,  which  had 
been  loosened  from  its  former  attachments  by  the  ulceration,  was  flattened 
and  depressed.     Reflecting  upon  the  case,  it  appeared  to  me  that  as  the 

29* 


342 


Pancoast's  Plastic  Operations, 


[Oct. 


margin  of  the  nostrils  and  the  columna  were  tolerably  perfect,  and  merely- 
drawn  out  of  shape  by  the  cicatrization,  ihey  might  be  loosened  by  an  inci- 
sion, and  drawn  down  so  as  to  be  useful  in  rebuilding  the  nose,  and  the 
breach  that  was  left  filled  up  by  flaps  taken  from  the  cheeks  or  forehead. 
But  in  this  case  I  preferred  to  take  them  from  the  cheeks,  as  these  were  full 
and  fleshy,  and  I  believed  it  possible  to  cut  the  flaps  in  a  peculiar  manner, 
so  that  when  twisted  round  to  fill  the  opening,  they  would  draw  by  their 
pedicle  upon  the  loosened  rim  of  the  nostril,  so  as  to  keep  the  tip  of  the 
nose  tilted  downwards,  and  thus  overcome  the  resiliency  naturally  to  be 
expected  in  these  parts,  which  had  long  been  confined  in  a  new  position. 

January  9th,  1841 — I  performed  the  operation  in  the  Philadelphia  Hos- 
pital, before  the  class  of  the  JeflTerson  Medical  College.  The  patient  was 
laid  upon  a  table,  and  his  head  supported  by  pillows.  I  commenced  by  dis- 
secting off  the  tegumentary  covering  of  the  depressed  cicatrix  just  below 
the  ossa  nasi,  so  as  to  get  a  bevelled  raw  surface,  upon  which  the  margins  of 
the  flaps  were  to  rest.  The  end  of  the  nose  was  separated  from  the  ossa 
nasi,  by  pushing  a  sharp-pointed  straight  bistoury  across  the  nose  with  the 
back  to  the  cheeks,  and  nearly  on  a  level  with  them,  and  cutting  outwards. 

Before  the  tip  of  the  nose  could  be  drawn  down  to  its  proper  position,  it 
was  found  necessary  to  divide  some  adventitious  adhesions  within  the  nostril. 
It  still  however,  had  a  strong  elastic  tendency  to  resume  its  former  position. 
This  was  almost  entirely  overcomej  by  extending  the  incision  of  the  cheek 
outwards  and  downwards,  through  the  root  of  the  oval  cartilage,  and  by  nick- 
ing the  inner  margin  of  the  same  with  a  probe-pointed  bistoury  introduced 
through  the  nostril  of  each  side.  A  triangular  flap  of  integuments  was 
then  marked  out  on  each  cheek  just  below  the  malar  protuberances,  of  the 
size  represented  in  the  cut,  to  fill  the  breach;  the  left  being  the  largest,  as 
Fig.  2.  on  that  siJe,    there   was   the  largest 

space  to  fill  up.  The  outer  limb  of 
the  triangle  was  rounded,  so  as  to 
give  a  prominence  to  the  ridge  of  the 
nose,  when  the  base  of  the  flaps 
should  be  brought  to  the  middle  line. 
The  flaps  were  circumscribed  by  an 
incision  through  the  skin,  bevelled  in- 
wards towards  the  centre  of  the  flaps, 
so  as  to  furnish  an  oblique  surface,  by 
which  they  might  rest  upon  the  nose. 
They  were  then  dissected  up,  with  as 
much  subcutaneous  cellular  tissue  as  possible,  without  involving  the  muscu- 
lar fibres.  Several  small  arteries  sprung,  but  the  hemorrhage  was  stopped 
by  torsion  without  ligature.  The  pedicle  of  each  flap  was  opposite  the  at- 
tachment of  the  oval  cartilage  upon  the  cheeks.  The  flaps  were  twisted 
round,  the  lower  margin  on  the  cheek  becoming  the  upper  margin  on  the 


1842.] 


Pancoast's  Plastic  Operations, 


343 


nose,  till  they  met  in  the  middle  line;  they  tilled  up  the  open  space  on  the 
nose  exactly,  and  the  effect  of  the  twisting,  was  to  hitch  up  the  root  of  each 
ala  and,  as  had  been  calculated  upon,  to  keep  the  tip  properly  depressed. 
The  flaps  were  now  fastened  to  each  other  on  the  dorsum,  and  on  the  sides 
to  the  adjoining  parts  of  the  nose,  with  small  palladium  pins  and  hare-lip 
sutures.  No  stitches  were  used.  The  upper  section  of  the  alae  adherent  to 
the  ossa  nasi,  having  from  the  contraction  of  the  margin  a  disposition  to  curve 
in,  and  fall  below  the  flaps,  it  was  found  necessary  to  make  a  vertical  cut 
through  it  on  each  side,  before  the  pins  were  applied,  when  all  the  parts 
were  brought  upon  a  level.  Before  fastening  the  inferior  margins  of  the  flaps, 
the  nostrils  were  lightly  stuffed  with  oiled  lint.  The  margins  of  the  wound 
upon  the  cheeks  were  brought  together  by  the  hare-lip  suture,  care  being 
taken  in  applying  the  pins,  so  that  the  stress  should  be  from  below  upwards 
towards  the  canthi  of  the  eye,  and  not  upon  the  middle  of  the  lower  eyelid, 
which  might  have  caused  ectropion.  The  oblique  direction  of  the  pins  at 
the  same  time  prevented  any  distortion  of  the  upper  lip.  The  cut  (Fig.  3) 
shows    the     ap-  Fig.  3. 

pearance  of  the 
parts,  when  the 
operation  was 
terminated.  The 
dressing  was 
completed  after 
the  manner  of 
Mr.  Listen,  by 
laying  over  the 
nose  lint  wet 
with  warm 

water,  and  co- 
vered with  oiled 

silk  to  prevent  evaporation.  The  eyes  were  also  covered,  and  the  patient 
directed  neither  to  open  ihem,  nor  attempt  to  speak.  The  whole  process  occu- 
pied an  hour,  and  though  necessarily  painful,  was  borne  by  the  patient  with- 
out a  murmur.  The  operation  was  performed  at  12  M.  The  flaps,  imme- 
diately after  the  dressing,  were  cold,  blue  and  insensible.  They  soon 
regained  their  natural  colour,  but  their  temperature  did  not  return  till  4  P.  M. 
The  patient,  after  the  operation,  was  affected  with  a  slight  rigor,  which 
disappeared  on  the  administration  of  some  warm  wine  and  water.  Twenty 
drops  denarcot  laud,  to  be  given  every  four  hours. 

12^  Night. — Considerable  tumefaction  of  the  flaps,  not  much  of  the  sur- 
rounding parts.     Starts  when  he  dozes. 

lOM. — Slight   but  general   tumefaction  of  nose  and  cheeks;    no  fever. 
Laudanum  continued.     Sago  for  diet. 

11/A.— Slept  well  during  the  night.  Some  fever  and  thirst.  Nose  swelled, 


344  Pancoast's  Plastic  Operations,  [Oct. 

bulbous  and  polished,  especially  at  extremity.  Some  erysipelatous  redness 
of  cheeks.  Withdrew  the  plugging  from  the  nose,  which  was  offensive 
from  the  blood  and  secretions  accumulated  in  it,  and  might  serve  to  prevent 
union  of  the  flaps  by  first  intention.  Some  bleeding  followed;  arch  of  the  nose 
was  well  preserved.  Dressed  nose  externally  with  aqua  plumb,  gvii.,  tinct. 
thebaic,  ^i.  Lint  to  be  steeped  in  the  lotion,  kept  on  the  nose  and  fre- 
quently wetted.     Salts  and  magnesia  to  be  taken  as  a  purge. 

VZth. — Greatly  improved.  No  fever;  swelling  of  nose  less;  redness  of 
face  gone;  wounds  of  face  seem  united  by  first  intention;  removed  all  the  pins 
from  the  cheeks,  allowing  the  ligatures  to  remain.  Removed  seven  from 
the  nose;  union  by  first  intention  between  the  new  and  old  portions  of  the 
nose  everywhere  except  at  the  bridge,  where  there  was  some  suppuration 
around  the  pins. 

IQth. — Suppuration  ceased  on  the  removal  of  the  pins.  The  ligatures 
that  were  round  the  pins  remained  adherent.     Same  dressing  continued. 

23^. — Ligatures  were  removed  on  the  20th.  Some  suppuration  on  the 
front  part  of  flaps  at  their  junction  on  the  ridge  of  the  nose.  A  short  pin  was 
found  here,  that  had  ulcerated  through  having  been  overlooked.  In  every  other 
part  union  complete  by  first  intention.  Nose  flabby  somewhat,  for  want  of 
cartilaginous  support,  bulging  a  little  along  the  seams.  Breathes  freely 
through  the  nostrils.  Closed  the  ulcerated  opening  with  adhesive  straps. 
Simple  dressings  applied.  The  nose  is  now  of  good  shape,  and  very  passable 
in  appearance. 

February  lOth. — The  ulcerated  portion  on  the  ridge  healed.  The  over- 
sight in  not  removing  the  pin  at  this  place,  has  caused  the  ridge  of  the  nose 
to  be  a  little  sunken  at  one  point.  The  tip  of  the  nose  preserves  its  natural 
position.  The  pedicles  of  the  flaps  project  a  little  out  upon  the  cheeks,  and 
the  flaps  themselves  rise  upon  the  sides  of  the  nose  a  little  above  the  general 
level.  This  seemed  to  be  the  resultof  the  traction  of  the  cicatrix  on  the  cheeks. 
Operated  to  remove  this  defect  as  follows:  divided  the  pedicles  transversely 
on  a  level  with  the  cheek;  cut  out  a  V  shaped  piece  of  integument,  with 
point  downward  upon  the  cheeks,  and  closed  the  edges  with  hare-lip  suture; 
cut  out  a  similar  piece  from  the  new  flaps  with  the  point  upward  upon  the 
side  of  the  nose,  and  closed  the  wound  in  like  manner.  This  double  opera- 
tion was  performed  on  both  sides  of  the  nose.  Its  object  was  to  diminish 
the  bulge  of  the  flap,  and  restore  an  even  groove  to  the  side  of  the  nose.  To 
restore  the  natural  sharpness  to  the  ridge,  and  to  remove  the  sudden  depres- 
sion at  the  front  part  of  the  new  structure,  which  gave  a  pug  like  rising  to 
the  tip,  I  cut  out  at  the  same  time  in  front  of  the  graft,  a  small  triangular  piece 
the  base  of  which  was  upwards,  and  covered  the  depressed  parts.  I  then 
made  raw  the  edges  of  the  flaps  on  the  ridge  of  the  nose;  dissected  up  the 
skin  of  the  grafted  pieces  on  each  side,  and  stretched  them  forward,  and 
fastened  the  parts  together  with  hare-lip  pins.  The  pins  were  removed  on 
the  third  day.  Every  step  of  the  second  operation  succeeded  perfectly,  ex- 
cept the  attempt  to  stretch  the  grafts  on  the  ridge  of  the  nose.     The  texture 


1842.] 


Pancoast's  Plastic  Operations. 


345 


Fig.  4. 


of  these  was  so  altered  that  it  would  not  bear  stretching  like  a  fresh  piece  of 
skin,  and  a  small  portion  of  the  margin  on  each  side  ulcerated.  Simple  dress- 
ings were  applied. 

March  1st. — The  ulcerated  edges  of  the  flaps  on  the  ridge  of  the  nose, 
being  left  too  high  for  the  general  level  of  the  nose,  they  were  rounded  off 
by  being  lightly  touched  with  caustic.  Stimulant  ointments  were  applied  to 
encourage  granulation. 

23c?. — The  deformity  on  the  ridge  of  the 
nose  entirely  removed.  Instead  of  a  slight 
roman  prominence  it  now  presents  more  the  ap- 
pearance of  a  well-formed  pug.  There  is  still 
some  tendency  in  the  roots  of  the  new  alas  to 
be  drawn  out  on  the  cheek.  In  order  to  prevent 
this,  directed  two  pieces  of  sheet-zinc,  moulded 
to  the  shape  of  the  cheek  and  nose,  to  be  worn 
fastened  together  with  strings  over  the  bridge, 
and  secured  with  a  riband  round  the  neck. 
This  effected  the  object  completely,  but  the 
patient  was  directed  to  wear  it  for  two  or 
three  months  at  least  during  the  night  time, 
to  preserve  the  shape  of  the  nose.  The  ac- 
companying cut,  (Fig.  4),  is  a  good  repre- 
sentation of  the  nose  ten  months  after  the 
operation.  In  the  fastening  of  the  flaps  in 
their  new  position,  I  followed  in  this  case  the 
plan  of  Dieffenbach  as  described  by  Zeis — the 
introduction  of  a  great  number  of  pins  close 
together,  which  were  covered  with  circular  ligatures  and  cut  short.  In 
subsequent  operations,  however,  I  have  not  followed  it,  as  I  have  not 
found  the  nice  adjustment  of  parts  accomplished  by  this  means,  to  compen- 
sate for  the  greater  irritation  and  liability  to  ulceration  to  which  it  gives  rise. 


Case  II. — Total  destruction  of  the  upper  lip,  the  soft  parts  of  the  7iose, 
the  septum  narium,  and  turbinated  bones.  Cheiloplastic  and  Rhinoplastic 
operation. — John  Glover,  the  unfortunate  subject  of  this  deformity,  a  native 
of  Bridgewater  in  England,  is  53  years  of  age,  but  has  the  appearance  of 
being  much  older.  Fig.  5  is  a  good  representation  of  his  appearance  taken 
from  a  drawing  by  Mr.  Schultz.  All  the  soft  parts  of  the  nose,  and  the 
whole  of  the  upper  lip,  from  the  commissures  of  the  mouth  up  to  the 
fossa  canina  of  each  side,  the  septum  narium  and  the  turbinated  bones 
were  removed.  The  cavities  of  the  antrum  highmorianum  were  opened 
on  each  side  by  destruction  of  bone,  so  as  form  a  mere  superficial  cavity  in 
which  the  ball  of  the  thumb  could  be  placed.  The  opening  of  the  sphenoid- 
al sinuses  were  distinctly  seen  through  this  cavern.  The  mucous  membrane 
lining  the  parts  seemed  now  healthy,  though  covered  with  lymphatic  exuda- 


346 


Pancoast's  Plastic  Operations, 


[Oct. 


Fig.  5. 


tions.  The  teeth 
with  their  sockets 
were  gone  from  the 
upper  jaw,  so  that 
from  its  arched  form 
it  was  reduced  to  a 
thin  plate.  The 
teeth  and  alveolar 
processes  were  also 
all  removed  from  the 
lower  jaw  without 
exception.  In  con- 
sequence of  their 
loss,  the  chin  had 
become  excessively 
prominent  as  in  ex- 
treme old  age;  and 
the  free  margin  of 
the  lower  lip  when 
the  mouth  was 
closed  came  up  to 
the  nasal  cavern,  and  covered  the  edge  of  the  upper  gum,  which  was  about 
two  lines  in  thickness.  The  appearance  of  the  mouth  closed  is  seen  in  fig.  5. 
In  the  cicatrization  which  followed  this  extensive  ulceration  of  the  parts, 
the  mouth  had  been  narrowed  by  union  of  the  lower  lip  for  about  half  an 
inch  from  each  corner  to  the  flesh  of  the  cheek  above,  the  line  of  cicatrization 
being  still  visible.  When  the  mouth  was  opened  to  its  widest  extent,  it 
formed  a  rigid  circular  orifice  three  quarters  of  an  inch  in  diameter,  through 
which  the  patient  could  with  difficulty  protrude  the  point  of  his  tongue,  and 
feed  himself  with  a  small  spoon.  This  extensive  destruction  of  parts  took 
place,  according  to  the  patienfs  statement,  eight  years  ago,  in  consequence 
of  a  violent  contusion  of  the  face,  received  from  the  handle  of  a  saw,  while 
superintending  the  labours  of  a  saw  pit.  He  was  under  the  care  of  Mr. 
Toogood  of  Bridgewater,  and  subsequently  that  of  Sir  Astley  Cooper,  in 
London,  after  the  parts  had  cicatrised,  for  the  purpose  of  having  something 
done  for  the  removal  of  the  deformity,  both  of  which  gentleman  considered 
the  case  so  hopeless  as  to  be  beyond  the  reach  of  any  operation  for  his  re- 
lief. Whatever  had  been  the  cause  of  the  disease,  he  was  now  an  object  of 
disgusting  deformity,  an  outcast  from  his  family  and  friends.  He  presented 
himself  to  me  for  relief,  January  14th,  1841,  anxious  to  submit  to  any  ope- 
ration that  might  diminish  his  deformity,  without  destroying  life.  As  his 
complexion  was  florid,  his  cheeks  full,  and  his  general  health  good,  I  deter- 
mined to  comply  with  his  wishes,  and  see  how  much  succour  surgical 
science  could  aflford,  in  a  case  apparently  so  desperate. 


1842.] 


Pancoast's  Plastic  Operations. 


347 


There  were  three  indications  to  fulfil  in  the  operation:  1st,  to  enlarge  the 
mouth  to  its  natural  dimensions;  2d,  to  cut  up  flaps  from  the  cheeks,  and 
reconstruct  the  upper  lip,  and  finally  after  the  new  lip  had  become  solid  and 
firm,  to  make  a  new  nose  by  reflecting  the  skin  from  the  forehead. 

January,  1841 — I  performed  the  (Fig.  6.) 

two  first  steps  of  the  operation  at 
the  Philadelphia  Hospital,  before 
the  class  of  the  Jeflferson  Medical 
College.  The  mouth  was  widened 
after  the  manner  of  Dieffenbach. 
One  blade  of  a  pair  of  sharp-pointed 
scissors  was  pushed  from  each  angle 
of  the  mouth  through  the  thickness 
of  the  lip,  for  three  quarters  of  an 
inch,  but  to  the  outer  side  of  the 
mucous  membrane,  and  the  skin 
and  muscular  structure  was  divided. 
Another  parallel  incision  was  made 
in  a  similar  manner  about  f^^ths  of 
an  inch  below  as  shown  in  the  dot- 
ted line  fig.  6.  The  ends  of  the 
incisions  were  joined  by  a  rounded 

cut  on  the  cheeks,  and  the  circumscribed  portions  removed,  leaving  the  mu- 
cous membrane.  The  mouth  was  opened,  the  stretched  intervening  mucous 
membrane  divided  in  the  middle  line,  and  each  half  bound  over  by  a  few 
stitches  to  its  corresponding  portion  of  cut  skin,  so  that  two  mucous  surfaces 


commg  in  contact  might  prevent 
the  reunion  of  the  divided 
cheeks.  The  next  step  was  to 
make  the  lip.  (See  Fig.  6  and  7.) 
I  made  raw  the  free  surface  of 
the  gum  with  a  bistoury;  then 
ran  an  incision  from  the  point 
where  the  gum  was  covered  by 
integuments  obliquely  upwards 
and  outwards  for  an  inch  and  a 
quarter.  From  the  termination 
of  this,  I  extended  another  out 
for  about  the  same  distance 
nearly  parallel  with  the  inci- 
sions for  widening  the  mouth, 
but  somewhat  inclined  down- 
wards. The  cheeks  were  loos- 
ened from  the  gum  and  malar 


(Fig.  7.) 


348  Pancoast's  Plastic  Operations,  [Oct. 

bone  by  some  incisions  on  the  side  of  the  mouth;  the  flap  of  skin  and  sub- 
cutaneous fatty  matter  down  to  the  muscles  was  next  raised  with  the  knife, 
beginning  the  dissection  at  the  angle  next  the  nose.  Several  branches  of  the 
infraorbital  and  facial  arteries  were  divided,  to  which  torsion  was  applied. 
The  flaps  of  the  two  sides  were  then  drawn  downwards  and  forwards  over  the 
raw  surface  of  the  gum,  and  fastened  together  with  three  hare-lip  pins.  The 
sloping  inner  edge  of  the  flaps,  when  thus  rotated  downwards,  fitted  accurate- 
ly. As  these  were  stretched  forwards,  the  general  integuments  of  the  cheeks 
advanced,  so  as  to  diminish  to  a  great  extent  the  space  from  which  the 
flaps  were  removed.  The  edges  of  this  space  were  closed  with  pins,  as  seen 
in  the  cut,  so  placed  as  not  to  give  rise  to  ectropion  by  drawing  on  the  lower 
eyelid.  The  integument  by  the  side  of  the  nasal  cavern  was  loosened  with 
the  knife  on  each  side,  and  fastened  with  a  cross-pin,  so  as  to  give  a  cuti- 
cular  covering  to  the  raw  margin  of  the  new  upper  lip.  The  face  was 
covered  with  lint,  directed  to  be  kept  constantly  wet  with  a  solution  of  lead- 
water  and  laudanum.  The  entire  operation  and  dressing  occupied  about  an 
hour  and  a  quarter,  but  was  borne  by  the  patient  without  a  murmur.  But 
little  blood  was  lost.  He  was  directed  to  lie  perfectly  quiet  in  bed,  and 
take  20  drops  denarcotised  laudanum  every  three  hours. 

For  the  following  notes  of  the  case  I  am  indebted  to  Dr.  George  New- 
bold,  the  junior  house-surgeon: — "In  the  afternoon  of  the  day  of  the  ope- 
ration, some  bleeding  occurred  on  the  left  side  of  the  face  from  a  small 
artery.  This  might  readily  have  been  arrested  by  a  compass  and  bandage. 
But  unfortunately  recourse  was  had  by  the  senior  resident  to  the  Tr.  ferri 
muriatis,  about  a  drachm  of  which  was  dropped  on  the  raw  edge  of  the  flap. 
This  not  answering,  another  cauterizing  lotion  was  applied,  which  stopped 
the  bleeding. 

*'  24/A.  Seen  again  this  morning  by  Dr.  Pancoast.  Much  mischief  had 
resulted  from  the  caustic;  some  erysipelatous  redness  of  left  side,  pain  felt 
in  the  left  cheek,  eye  and  forehead;  had  slept,  however,  several  hours  during 
the  night;  everything  removed  that  had  been  wetted  with  the  caustic.  Lead 
water  and  laudanum  applications  resumed;  laud.  gt.  xx.  every  three  hours. 

"  2fith.  Slept  tolerably  well  last  night,  though  troubled  with  cough;  some 
tumefaction  of  left  cheek;  enema  to  open  bowels;  takes  gruel  freely. 

"  26/A.  Slept  well  last  night;  some  cough  continues.    Continue  treatment. 

"  21th.  Had  an  opiate  enema  in  the  evening;  slept  tolerably  well  during 
the  night;  redness,  swelling  and  pain  of  left  side  of  face  diminished;  some 
soreness  of  right  side  of  face;  mutton  tea  for  diet.  Lac.  assafoet.  5j.;  laud.  gtt. 
XX.  every  three  hours.    Continue  lotion.    Upper  pin  of  lip  removed  to-day. 

"  2Sth.  Slept  well;  cough  better.     Continue  treatment. 

*'  29/A.  Slept  well  last  night;  cough  less  troublesome;  last  pin  removed 
this  morning;  firm  union  of  new  lip  in  median  line.  During  the  day  some 
bleeding  again  from  the  wound;  sent  for  Dr.  P.,  who  applied  a  compress  and 
bandage,  which  stopped  it.     Has  slight  fever;  laud,  and  assafoetida  stopped; 


1842.] 


Pancoast's  Plastic  Operations. 


349 


mist,  neutralis,  ^vi.;  morph.  acet.  gr.  j.     Pot.  nitrat.  ^j. — 5SS  every  hour; 
purgative  enema.     Gruel  and  sago  for  diet. 

*' 30^/i.  Slept  very  well  early  part  of  night;  cough  troublesome  towards 
morning;  no  hemorrhage;  no  fever;  wound  united  everywhere  by  first 
intention  except  on  left  side,  where  suppuration  and  ulceration  had  followed 
the  use  of  the  styptic;  covered  the  ulcerated  surface  with  lint  steeped  in 
warm  water  to  promote  granulation.     Treatment  continued. 

31  s^  Doing  well.     Continue  treatment. 

^^  February  3d.  Very  comfortable;  has  slept  well;  no  pain  except  under 
left  eye;  free  suppuration  on  left  cheek,  followed  by  granulation.  Yesterday 
lower  edge  of  the  new  lip  gave  way  in  the  median  line;  supported  it  with 
adhesive  straps.     Takes  mutton  tea. 

"  I6th,  Has  continued  steadily  improving;  dressed  to-day  and  m.oved 
about  the  ward;  union  of  the  lip  in  the  middle  line  complete;  the  ulcer  of 
the  left  side  following  the  use  of  the  styptic  nearly  closed.  The  process  of 
cicatrization  has,  however,  shortened  and  narrowed  the  lip  on  that  side,  so 
as  to  draw  in  a  little  the  corner  of  the  mouth." 

March  27th.  The  new  lip  being  now  firm,  and  united  with  the  gum, 
though  drawn  in  and  narrowed  somewhat  on  the  left  side  by  the  contraction 
following  the  slough  produced  by  the  muriated  tincture  of  iron,  I  proceeded 
to  the  restoration  of  the  nose,  assisted  by  Drs.  J.  K.  Mitchell,  Peace,  Bour- 
nonville,  and  in  presence  of  the  hospital  class.  The  hair  was  shaved 
from  the  temples  and  forehead,  the  nasal  opening  stopped  with  lint,  to 
keep  the  blood  from  entering  and  passing  down  the  throat,  and  the  patient 
placed  upon  the  operating  table,  his  head  supported  with  a  pillow.  A  flap 
was    raised   from    the  (Fig.  8.) 

forehead:  inclining  the 
blade  of  the  knife  out- 
wards, I  divided  the 
skin  with  a  single 
sweep,  so  as  to  cut  a 
bevelled  edge,  of  the 
shape  indicated  in  the 
cut,  (Fig.  8,)  which 
had  been  previously 
traced  with  lunar  caus- 
tic. The  apex  about 
fths  of  an  inch  wide 
rested  between  the 
eyebrows,  and  the 
tongue-like  portion  for  ^ 
the  column  stretched 
up  into  the  scalp.  The 
flap  was  near  three  inches  wide  at  its  base,  and  was  cut  up  larger  than  seemed 
No.  VIII.— October,  1842.  30 


350  Pancoast's  Plastic  Operations.  [Oct. 

necessary  as  I  believed  the  natural  retractility  of  the  skin  would  cause  it  to 
shrink  in  at  least  the  eighth  of  an  inch  all  round;  and  my  calculation  proved 
correct.  Pressure  was  made  on  the  temporal  arteries,  while  I  raised  the  flap, 
which  took  but  a  few  moments.  A  small  strabismus  hook  I  found  useful  in 
raising  the  column  at  the  commencement  of  the  dissection.  The  flap  after  being 
dissected  up  was  turned  down  on  the  left  side,  wrapped  in  linen,  and  the  wound 
in  the  forehead  drawn  up  with  four  hare-lip  sutures.  The  large  wound  of  the 
forehead  was  thus  narrowed  down  at  once  as  seen  in  cut  (Fig.  8,  A.)  by  clos- 
ing up  the  angles  of  the  wound,  so  as  to  leave  a  small  raw  surface  in  the  centre 
not  much  larger  than  a  quarter  dollar;  its  surface  was  dressed  with  raw  lint; 
a  couple  of  adhesive  straps,  and  over  these  simple  dressings  of  lint  spread 
with  cerate,  and  a  roller  were  applied.  A  narrow  fissure  existed  at  the  lower 
part  of  the  wound  after  the  application  of  the  pins.  I  next  made  raw  the 
surface  of  the  new  lip  and  gum.  An  incision  down  to  the  bone  was  then  carried 
round  the  margin  of  the  nasal  chasm.  I  dissected  the  integuments  each  way 
from  this  incision,  so  as  to  leave  a  groove  between  them  for  the  lodgment  of 
the  edges  of  the  new  nose.  The  inner  margin  was  raised  up  so  as  to  form  a 
vertical  wall,  the  raw  surface  of  which  was  to  come  into  contact  with  the 
raw  side  of  the  flap,  and  thus  give  an  increased  probability  to  the  adhesion 
of  the  graft;  and  to  render  this  still  more  certain,  the  triangular  piece  of  skin 
enclosed  by  the  groove  at  the  end  of  the  ossa  nasi,  was  cut  away,  and  the 
cuticle  pared  off"  from  the  edges  of  the  new  nose.  Three  waxed  silken  liga- 
tures, with  a  needle  at  each  end,  were  placed  at  each  side,  by  passing  one 
needle  from  without  inwards  through  the  inner  wall  of  the  groove,  and  again 
;in  the  opposite  direction  about  an  eighth  of  an  inch  above,  so  as  to  leave 
the  two  needles  resting  on  the  cheek,  with  a  loop  through  the  inner  wall,  as 
seen  in  fig.  8.  The  flap  from  the  forehead  was  then  rotated  upon  its  root  to 
the  right,  the  incision  being  carried  a  little  lower  down  on  the  left  side  than 
the  right,  to  enable  it  to  turn  without  stopping  the  circulation.  There 
was  but  little  oozing  from  the  flap,  and  it  retained  its  natural  colour. 
The  two  needles  at  the  end  of  each  ligature,  were  then  passed  through  the 
margin  of  the  flap  from  within  outwards,  and  again  through  the  integuments 
on  the  outer  side  of  the  groove,  so  that  when  they  were  drawn  they  neces- 
sarily sunk  the  edge  of  the  flap  to  the  bottom  of  the  groove,  and  brought 
four  raw  surfaces  into  contact.  The  dots  on  the  flap  fig.  8,  represent  the 
points  through  which  the  threads  of  each  ligature  were  passed,  after  the 
flap  was  twisted  round.  They  were  tied  over  small  rolls  of  adhesive 
plaster  after  the  manner  of  Labat,  so  as  not  to  strangulate  the  parts  included 
in  the  loop.  The  middle  of  the  three  ligatures  were  placed  a  little  farthest 
from  the  free  margin,  and  tied  over  a  roll  of  plaster  three  quarters  of  an  inch 
long,  which  rested  against  the  flap,  and  sunk  it  in  so  as  to  support  the  side 
of  the  nose,  and  give  the  depression  naturally  existing  above  the  oval  carti- 
lage. The  left  margin  of  the  new  nose,  was  secured  before  the  right,  in 
order  to  give  greater  facility  in  the  nice  adjustment  of  the  ligatures.  A  small 
ligature  was  then  passed  through  each  edge  of  the  integuments  of  the  new 


1842.] 


Pancoast's  Plastic  Operations. 


351 


column  near  its  root,  and  tied  upon  one  side,  so  as  to  give  a  rounded  form  to  the 
column,  by  bringing  the  two  lateral  surfaces  together  posteriorly,  and  also  to 
prevent  its  adhering  to  the  margins  of  the  new  alas.  The  cuticle  was  removed 
from  the  lower  end   of  the  column  by  a  Fig^.  9. 

bevelled  cut;  the  column  was  then  pushed 
in  upon  the  gum,  and  secured  upon  the 
new  upper  lip  by  two  pins,  one  of 
which  was  semicircular.  The  flap  was 
insensible,  did  not  bleed,  but  was  mottled 
over  with  a  few  drops  of  blood.  It  was 
natural  in  colour,  except  a  slight  bluish 
tint  upon  the  sides.  A  piece  of  lint  dip- 
ped in  oil,  was  passed  on  each  side  up 
the  new  nostril;  another  was  laid  on  each 
side  of  the  nose  over  the  ligatures.  Lint 
spread  with  cerate,  was  laid  upon  the 
sides  of  the  nose  and  over  the  wound  be- 
tween the  eyebrows;  the  whole  secured 
with  a  split  adhesive  strap  brought  down 
from  the  forehead.  The  patient  was  put 
to  bed,  to  have  ten  drops  acet.  opii  every  three  hours.  Lead-water  and 
laudanum  constantly  applied  over  the  dressings;  to  live  on  acidulated  gruel, 
and  to  be  watched  night  and  day,  lest  he  should  by  some  involuntary  motion 
of  the  hand,  disturb  the  attachment  of  the  newly-grafted  nose. 

The  operation  and  dressing  occupied  but  little  more  than  an  hour,  and  was 
borne  by  the  patient  almost  without  a  complaint.  Not  more  than  six  ounces  of 
blood  were  lost.  Some  little  delay  occurred  during  the  latter  part  of  the  opera- 
tion, by  the  blood  llowing  into  the  throat,  causing  the  patient  to  rise  up  and 
spit.  Li  consequence  of  the  peculiar  form  of  the  flap,  and  the  new  method 
of  fastening  in  a  groove  adopted  in  this  case,  the  nose  presented  immedi- 
ately after  the  operation,  much  of  the  natural  appearance  of  the  organ. 
It  was  much  larger  than  was  needed,  in  order  to  admit  of  the  shrinking 
and  contraction  that  must  necessarily  follow  the  cicatrization  of  its  under 
surface,  and  was  held  so  firm  in  its  place  as  to  be  incapable  of  being  moved 
by  the  respiratory  efforts,  as  is  described  to  be  usually  the  case  in  the  ordi- 
nary form  of  fastening,  in  which  the  bevelled  edge  of  the  flap  is  merely 
secured  in  contact  with  the  bevelled  edge  of  the  nostril.  Fig.  9,  and  10,  for 
which  I  am  indebted  to  the  pencil  of  Mr.  Neagle,  represent  very  accurately 
the  front  and  profile  views  of  the  nose,  immediately  after  the  operation.  An 
hour  after  the  operation,  an  oozing  of  arterial  blood  took  place  at  the  left 
side  of  the  pedicle,  where  the  angular  artery,  or  a  branch  of  it  had  been 
divided;  a  little  scraped  lint,  with  a  compress  and  bandage,  with  cold  lead- 
water  and  laudanum  applications,  speedily  arrested  it.  The  patient  slept 
pretty  well  the  following  night.  The  succeeding  day  he  suffered  with  head- 
ache, which  was  relieved  by  a  mercurial  cathartic. 


352 


Pancoast's  Plastic  Operations. 


[Oct. 


On  the  30th,  he  complained  of  nothing  but  some  soreness  and  sense  of 
tightness  of  the  integuments  of  the  forehead.     On  the  31st,  the  fourth  day 
Fig- 10.  after  the  operation,  the  dressings  were 

removed;  union  by  first  intention  had 
taken  place  throughout  the  whole 
line  of  insertion  of  the  new  nose  and 
column,  with  the  exception  of  a 
small  space  at  the  upper  part  of  the 
right  margin,  where  the  contraction 
on  that  side  of  the  pedicle  had 
slightly  raised  the  graft  out  of  the 
groove  causing  the  upper  ligature  of 
that  side  to  cut.  At  this  place  there 
was  a  slight  degree  of  suppuration. 
The  lint  around  which  some  sup- 
puration had  taken  place,  was  with- 
drawn from  the  cavity  of  the  nose; 
a  small  discharge  of  blood  from  the 
inner  surface  of  the  flap  followed. 
The  nose  retained  its  shape,  colour, 
and  sensibility  nearly  perfectly.  The 
sense  of  touch  upon  it,  was  referred  to  the  forehead.  The  pins  and  sutures 
were  all  removed;  some  oiled  lint  was  again  introduced  into  the  nostrils  to 
prevent  union  between  the  alas  and  the  new  column.  The  free  edges  of  the 
alae  and  the  column,  presented  a  sort  of  amber  coloured  facing,  the  first  step 
towards  cicatrization.  The  pins  were  removed  from  the  forehead.  At  the 
three  upper  angles  of  the  wound,  complete  union  had  taken  place.  The 
lower  pin  had  partially  cut  out,  and  there  was  some  erysipelatous  redness 
along  the  eyebrows.  The  central  space  and  the  lower  fissure  was  filled, 
nearly  to  the  level  of  the  surrounding  skin,  with  gray  lymph.  The  fore- 
head was  well  cleaned,  and  adhesive  straps  with  simple  dressing  and  a  band- 
age applied.  Simple  dressing  was  made  on  the  sides  of  the  nose,  which 
were  held  down  by  a  split  adhesive  strap  attached  above  to  the  dressing  of 
the  forehead.  Slight  support  was  also  given  in  the  same  way  to  the  lower 
part  of  the  column. 

*3pril  2d. — The  patient  has  slept  well,  had  a  good  appetite,  and  sufi'ered 
little  or  no  inconvenience.  The  dressings  were  removed  and  readjusted  as 
before.  The  redness  of  forehead  had  disappeared,  and  free  suppuration 
had  taken  place  from  the  central  and  lower  part  of  the  wound.  The  nose 
was  perfectly  united  everywhere  upon  the  face.  At  the  upper  part  of  the 
right  line  of  attachment,  where  the  flap  was  found  a  little  raised  at  the  last 
dressing,  the  cuticle  of  the  cheek  was  slightly  rolled  away  from  the  wound, 
but  union  was  firm. 

The  after  treatment  of  the  case  was  not  attended  with  any  thing  very 


^', 


i842.]  Pancoast's  Plastic  Operations,  353 

peculiar.  The  wound  of  the  forehead  healed  up  under  the  ordinary  means 
of  treatment,  leaving  only  a  small  cicatrix,  almost  entirely  hidden  by  the 
drooping  hair  of  the  front  part  of  the  head.  The  patient  was  no  longer  con- 
fined to  his  bed.  From  the  thickness  of  the  skin  of  the  forehead,  which  was 
greater  than  usual,  and  from  the  ample  amount  of  integument  taken  up 
which  admitted  of  a  free  shrinking  of  the  superficial  dimensions  and  thick- 
ening of  the  substance  of  the  new  nose,  as  well  as  from  the  firm  manner  in 
which  it  was  embedded  in  the  groove,  its  alse  retained  their  position  so  per- 
fectly after  the  second  dressing  as  to  require  no  stufiing  or  support.  The  inner 
surface,  after  suppurating  for  some  time,  gradually  glazed  over  and  became 
covered  with  an  epithelium.  The  greatest  difficulty  experienced  was  in  the 
preservation  of  well-shaped  openings  to  the  nostrils,  so  great  was  the  ten- 
dency of  the  edges  of  the  alse  and  column  to  unite  together  by  intermediate 
granulations.  This  result  was  obviated  by  pressure  made  with  tubes 
constandy  worn  in  the  nostrils  for  several  weeks.  So  little  was  the  vitality 
of  the  flap  impaired  by  its  transplantation,  that  at  the  end  of  ten  days,  the 
hair  had  visibly  grown  on  the  surface  of  the  column  and  the  tip  of  the  new 
nose,  which  had  been  taken  from  the  hairy  portion  of  the  scalp.  The  pilife- 
rous  follicles  even  on  the  bevelled  edge  of  the  column  which  had  become 
adherent  to  the  new  upper  lip,  threw  out  a  growth  of  hair,  which  by  the 
irritation  and  suppuration  it  produced,  caused  by  the  end  of  the  second  week, 
a  detachment  of  the  lower  end  of  the  column.  The  column  being  thus 
loosened,  was  disposed  to  curl  inwards,  in  consequence  of  the  cicatrization 
of  its  inner  or  raw  surface.  To  prevent  this  at  the  end  of  the  third  week, 
the  hair  was  carefully  shaved  away;  and  the  column  reattached  to  the  lip  after 
a  deep  bevelled  cut  had  been  made,  which,  it  was  believed,  would  destroy  the 
follicles.  Reunion  again  took  place;  but  the  growth  of  the  hair  a  second 
time  against  the  cicatrized  surface  of  the  new  lip,  to  which  the  column  was 
attached,  was  found  on  examination,  some  months  afterwards,  to  have 
caused  once  more  a  separation.  But  the  column  no  longer  was  disposed  to 
curve  inwards;  its  end  rested  in  a  small  notch  in  the  upper  lip,  and  a  want 
of  union  was  only  perceived  when  an  attempt  was  made  to  move  the  column. 
May  8th.  The  nose  being  now  firmly  adherent  to  the  face  so  that  the 
seam  of  union  on  the  cheeks  is  scarcely  obvious,  natural  in  colour  and 
appearance,  and  the  process  of  shrinking  and  contraction  having  in  a  great 
measure  been  arrested,  the  new  blood-vessels  which  entered  it  by  the  sides 
of  the  face  were  believed  to  be  sufficient  for  its  nourishment.  Its  pedicle, 
which  contained  the  angular  arteries,  was  accordingly  divided.  A  director 
for  this  purpose  was  passed  between  it  and  the  bridge  of  the  nose,  where 
there  was,  of  course,  no  adhesion  of  parts,  and  the  pedicle  divided  from  the 
left  to  the  right  side  obliquely  upwards.  A  loose  triangular  lamen  was  thus 
left  attached  to  the  new  nose,  which  shortened  itself  considerably  after  divi- 
sion. The  bleeding  from  the  angular  arteries  was  slopped  by  pinching  with 
the  forceps.     The  triangular  lamen  was  diminished  by  paring  on  the  sides, 

30* 


354 


Pancoast's  Plastic  Operations. 


[Oct. 


a  portion  of  its  inner  surface  shaved  off,  and  smoothly  fitted  down  over  the 
root  of  the  ossa  nasi  into  a  cavity,  made  by  the  excision  of  a  portion  of  the 
subjacent  integument  for  the  purpose.  A  few  stitches  of  the  interrupted 
suture  and  a  compress  and  bandage  completed  the  dressing.  On  the  third 
day  the  sutures  were  removed.  Some  suppuration  had  taken  place  along 
the  left  line  of  junction,  and  there  was  considerable  tumefaction  of  both 
canthi.     By  the  twelfth  day,  the  union  was  smooth  and  perfect. 

The  shortening  of  the  left  side  of  the  mouth  brought  on  as  described,  page 
343,  was  next  removed  by  a  simple  operation.  An  incision  through  the 
whole  thickness  of  the  parts  was  carried  obliquely  downwards  and  outwards 
from  the  left  commissure,  and  the  lower  lip  pinned  with  the  hare-lip  suture 
outwards  and  backwards,  so  as  to  give  greater  length  and  breadth  to  the  upper 
lip,  a  part  of  the  upper  line  of  the  incision  constituting  a  portion  of  its  free 
border.  A  slight  enlargement  of  the  mouth  was  also  made  in  the  same 
manner  on  the  right  side;  union  took  place  readily  by  first  intention.  Some 
puckering  of  the  parts,  remaining  below  the  left  commissure,  was  gradually 
removed  by  interstitial  absorption.  A  good  upper  lip  now  existed,  perfect 
indeed,  with  the  exception  of  its  being  a  little  crescentic  on  its  lower  mar- 
gin. The  accompanying  cut  is  a  faithful  representation  of  the  patient's  face, 
Fig-  n.  taken  from  a  draw- 

ing made  at  the  time 
of  his  leaving  the 
hospital.  Rewarded 
for  all  the  suffering 
he  had  undergone, 
by  a  restoration  of 
his  features  beyond 
his  most  sanguine 
expectations,  he  sent 
over  to  England  for 
his  family,  and  en- 
gaged himself  as  a 
collier  in  the  mines 
at  Pottsville. 

The  nose  was  of 
such  a  shape  and  so 
much  in  keeping 
with  the  other  parts 
of  the  face,  as  not  to 
attract  any  particular 
observation  from  strangers.  With  the  exception  of  a  slight  drooping  at  the 
apex,  and  a  sort  of  abruptness  at  its  line  of  connection  with  the  cheeks,  it 
could  scarcely  be  distinguished  from  a  natural  organ.  Seldom,  perhaps,  has 
a  plastic  operation  been  undertaken  under  more  disadvantageous  circum- 


1842.] 


Pancoast's  Plastic  Operations, 


355 


stances,  and  the  supplying  of  three  such  important  features  in  one  face,  as 
the  mouth,  nose,  and  upper  lip,  could  hardly  fail  to  be  appreciated  at  its  just 
value,  by  any  one  who  has  suffered  so  horrible  a  mutilation.  I  have  had  to- 
day, June  5th,  1842,  an  opportunity  of  inspecting  the  patient,  who  has  en- 
tered the  hospital  for  a  medical  affection,  where  he  has  been  seen  by  a  num- 
ber of  physicians.  In  the  year  and  a  half  which  has  elapsed  since  the  ope- 
ration, there  has  been  little  perceptible  alteration  in  the  new-made  parts;  and 
when  the  nose  is  touched,  the  sensation,  which  is  obscure,  is  still  referred  to 
the  forehead. 


Case  III.  Mrs.  Litzenburg,  setat.  43,  residing  in  Locust  Street,  near 
Schuylkill  Third,  for  two  years  suffered  with  an  extensive  scrofulous  ulcer- 
ation of  the  nasal  fossae  (ozosna),  which  resulted  in  the  entire  destruction 
of  the  septum  narium,  the  columna  nasi,  and  the  inferior  turbinated  bones« 
The  ulceration  has  been  so  extensive  on  Cf'ig-  l^O 

the  inner  surface  of  the  right  ala  as  to 
involve  the  cartilages  and  the  skin;  and  as 
cicatrization  took  place,  the  ala  was  drawn 
up  and  shortened  to  one  half  its  length,  and 
at  the  same  time  doubled  inwards  towards 
the  cavity  of  the  nose,  so  as  to  present  a 
deep  groove  on  its  outer  face,  which  was 
sunk  in  below  the  level  of  the  nasal  pro- 
cess of  the  upper  maxillary  bone.  The 
left  ala  was  shortened  to  nearly  the  same 
extent,  but  not  sunk.  The  tip  of  the  nose 
was  curled  inwards  by  the  cicatrization, 
and  elevated  in  about  the  same  propor- 
tion. The  upper  lip,  unsupported  by  the 
column,  had  fallen  down  below  its  natu- 
ral level,  and  was  rendered  thick  and  tumid  by  the  scrofulous  inflammation 
it  had  undergone;  (see  cut,  fig.  12.)  Having  placed  her  for  eight  months 
under  appropriate  treatment,  the  tendency  to  scrofulosis,  it  was  beheved, 
was  so  far  removed  as  to  warrant  an  attempt  to  cure  the  deformity. 

The  first  object  in  the  operation  was  to  form  a  new  column;  and  subse- 
quently to  restore  the  deformed  ala  to  its  proper  shape. 

June  llth,  1842,  at  the  Clinique  of  the  Jefferson  Medical  College,  I  pro- 
ceeded to  the  first  step  of  the  operation.  With  Dieffenbach's  sharp-pointed 
scalpel  I  pared  off  the  inner  surface  of  the  inverted  apex  of  the  nose.  A 
sharp-pointed  bistoury  was  twice  entered  just  below  the  opening  of  the 
nares,  and  the  lip  divided  throughout  its  whole  extent  by  two  incisions,  each 
one  parallel  with,  and  an  eighth  of  an  inch  to  one  side  of  the  median  line. 
The  coronary  artery  of  each  side  was  compressed  with  the  thumb  and  fin- 
ger of  an  assistant.  The  new  column  was  then  raised  up  without  twisting, 
its  frenum  divided  with  a  stroke  of  the  knife,  its  prolabial  surface  shaved  off, 


356 


Pancoast's  Plastic  Operations, 


[Oct. 


and  fastened  with  a  hare-lip  suture  to  the  raw  apex  of  the  nose,  as  seen  in 
the  cut  (Fig.  13.) 

An  obliquely  ascending  incision,  about  f^g^ths  of  an  inch  long  was  made  in 
(Fig.  13.)  the  lip  on  either  side  of  the  root  of  the 

new  column,  see  fig.  12,  so  as  to  enable  me 
to  make  a  perfect  closure  of  the  divided  lip 
below  it,  which  was  accomplished  with 
two  ordinary  hare-lip  sutures.  The  im- 
mediate effect  of  the  operation,  by  narrow- 
ing the  lip  and  raising  it  with  the  elevation 
of  the  column,  was  to  improve  its  appear- 
ance by  reducing  it  to  about  its  natural 
dimensions.  No  stuffing  was  made  of 
the  nostrils,  for  fear  of  re-exciting  ulcer- 
ation, and  no  dressing  was  applied  ex- 
cept a  small  greased  compress  and  roller 
to  support  the  new  column. 
14/^.  The  two  upper  pins  were  removed. 

\^th.  The  last  pin  was  withdrawn,  and  union  was  found  everywhere 
complete  by  first  intention. 

IKth.  She  indulged  in  a  fit  of  laughter;  some  giving  way  was  felt  in  the 
upper  part  of  the  lip,  attended  with  a  little  discharge  of  blood.  I  found,  on 
my  visit,  that  the  upper  ligature  of  the  lip  which  had  remained  adherent  was 
now  loosened;  it  was  taken  away;  a  small  gap  existed  below  the  root  of  the 
column,  which  was  filled  with  lymph.  The  parts  were  drawn  together 
with  adhesive  plaster,  and  by  the  19th  union  was  again  complete. 

The  mucous  membrane,  which  now  formed  the  outer  surface  of  the  new 
column,  (the  lateral  surfaces  which  were  glazed  over,)  was  gradually  con- 
verted into  skin,  though  it  remained  for  some  time  red  and  tumid,  and  when 
pressed  upon,  felt  like  a  pellicle,  below  which  was  confined  some  air  or 
fluid.  The  column  gradually  contracted  in  its  length,  with  the  effect  of 
lowering  very  considerably  the  apex  of  the  nose,  and  giving  a  slight  addi- 
tional elevation  to  the  upper  lip. 

July  22d.  Mrs.  L.  again  appeared  at  the  Clinique  for  the  purpose  of  hav- 
ing the  second  part  of  the  operation  performed.  The  patient  was  singularly 
improved  in  appearance;  the  apex  of  the  nose  had  descended  so  that  this 
organ  bore  now,  when  viewed  in  profile  on  the  left  side,  a  perfectly  natural 
appearance,  with  the  exception  of  the  lower  surface  of  the  column,  which 
was  as  yet  a  little  too  red  and  tumid. 

The  right  ala  was  shortened  and  depressed  as  before  described,  and  there 
was  an  unusual  fulness  of  the  side  of  the  cheek,  made  by  the  curling  of  the 
cartilage,  at  its  place  of  junction  with  the  lower  surface  of  the  nasal  bone. 
Introducing  the  handle  of  the  scalpel  into  the  nostril,  and  pressing  so  as  partly 
to  efface  the  depression,  an  irregular  elliptical  piece  (see  fig.  14,)  was  removed 
with  the  bistoury  through  the  whole  thickness  of  the  sunken  portion.     The 


1842.] 


Pancoast's  Plastic  Operations. 


357 


margin  of  the  nostril,  which  was  healthy,  as  seen  in  the  cut,  was  not  divided, 
but  the  two  incisions  enclosing  the  piece  (Fig.  14.) 

to  be  removed  were  curved  obliquely  up- 
wards and  forwards,  following  the  sweep 
of  the  oval  cartilage,  so  as  to  enable  me  to 
loosen  the  margin  of  the  nostril,  and  draw 
it  downwards,  and,  at  the  same  time,  cut 
away  the  lower  portion  of  the  lateral  carti- 
lage, which  was  strongly  twisted  inwards 
by  the  previous  ulceration.  The  end  of 
the  nostril,  thus  loosened,  was  then  drawn 
downwards  to  its  natural  position,  advanc- 
ing considerably  beyond  the  upper  half  of 
the  ala.  Two  hare-lip  pins  were  then 
introduced  through  the  upper  section  of 
the  ala,  and  brought  out  obliquely  down- 
wards through  the  lower.  These  were 
wrapped  with  thin  ligatures;  the  sides  of 
the  oval  readily  came  in  contact,  and  some 
oiled  lint  was  introduced  into  the  nostril  to  support  the  parts.  The  depression 
was  completely  effaced,  and  the  nose  perfectly  restored  to  its  proper  shape. 
From  the  advancement  of  the  end  of  the  nostril  downwards  and  forwards 
there  was  a  slight  doubling  of  its  cut  margin  near  the  apex,  which  was 
steadied  with  a  hare-lip  pin  of  small  size.  Very  considerable  hemor- 
rhage attended  the  operation,  which  was  finally  arrested  by  introducing  a 
little  more  lint  into  the  nostril,  and  laying  a  compress  and  bandage  on  the 
outer  side  of  the  nose.  Cold  astringent  lotions  were  directed  to  be  applied 
to  the  part,  the  patient  to  be  put  on  a  moderate  diet,  and  confined  to  a  dark- 
ened room.     20  gtt.  acet.  opii,  to  be  taken  three  times  a  day. 

24/A.  The  patient,  who  is  inclined  to  hysteria,  suffers  with  headache;  has 
felt  no  pain  in  the  face,  and  had  no  hemorrhage  from  the  nose;  slept  a  good 
part  of  the  night.     To  take  to-day,  ol.  ricini,  5j. 

25^/j.  The  two  upper  pins  were  removed;  union  appeared  complete  below 
them. 

2Qth,  Last  pin  removed;  nose  retains  its  shape  perfectly,  and  there  is  no 
disposition  in  the  ala  to  fall  in.  The  patient  suffered  so  little  inconvenience 
from  the  operation,  that  she  came  of  her  own  accord  on  foot  to  the  Clinique, 
a  mile  distant  from  her  dwelling.  No  further  difficulty  occurred  in  the 
treatment,  except  the  necessity  for  a  couple  of  weeks  of  applying  pressure 
with  adhesive  straps  and  a  roller,  in  order  to  set  the  column  well  upwards, 
and  overcome  some  pendant  tumidity,  which  it  possessed.  The  success  of 
this  method,  which  is  in  some  respects  new,  for  restoring  the  ala  and  nostril 
to  their  former  shape,  has  been  so  complete  as  to  warrant  me  in  recommend" 
ing  it  to  the  notice  of  the  profession. 


358  Horner's  Treatment  of  Hemorrhoids,  [Oct. 


Art.  XII. — Treatment  of  Hemorrhoids.     By  Wm.  E.  Horner,  Pro- 
fessor of  Anatomy  in  the  University  of  Pennsylvania. 

Two  methods  of  removal  are  resorted  to  in  the  United  States;  the  one 
immediate  excision,  the  other  strangulation  by  wire  ligature.  The  French 
practice  of  the  actual  cautery,  has  few  or  no  advocates.  The  first  mode  is 
followed  in  some  cases  by  enormous  and  alarming  hemorrhage,  which  in  one 
instance  I  have  known  to  be  ultimately  fatal.  The  wire  ligature  is  occasion- 
ally attended  with  an  agonizing  and  excessive  pain,  which  lasts  from  two 
days  to  a  week,  depriving  the  patient  of  sleep,  and  sometimes  producing 
general  spasm.  Tlie  above  consequences  are  points  of  familiar  and  distress- 
ing experience  to  surgeons. 

From  four  to  six  weeks  are  not  unfrequently  consumed,  in  the  entire  course 
of  treatment  by  excision  or  the  wire.  The  steps  taken  by  myself  present 
a  combination  of  measures  arising  from  these  two  dissimilar  modes  of  ope- 
rating, and  leave  the  patient  well,  in  from  two  to  three  weeks  in  bad  cases, 
and  in  a  shorter  time  in  mild  ones. 

The  plan  here  recommended,  is  to  calm  the  rectum  by  cold  water  injec- 
tions for  some  days  before  the  operation;  a  precaution,  the  value  of  which, 
I  have  learned  from  one  of  the  best  and  most  experienced  surgeons  we  have, 
my  friend  Dr.  Thomas  Harris,  of  the  United  States  Navy.  The  rectum 
being  empty  at  the  time  of  operating,  the  patient  by  straining  in  a  squatting 
posture,  forces  the  tumour  or  tumours  out.  He  then  goes  to  bed,  and  rests 
on  the  side  corresponding  with  the  tumour,  and  near  the  edge  of  the  bed. 
A  thick  sail  needle  armed  with  a  large  ligature,  is  then  passed  transversely 
through  the  upper  part  of  the  base  of  the  tumour;  the  needle  being  removed 
from  the  ligature,  the  two  ends  of  the  latter  are  tied  together,  so  as  to  form 
a  loop.  A  stout  awl  then  transfixes  the  lower  part  of  the  base  of  the  tumour 
in  a  line  parallel  with  the  ligature  above. 

In  a  large  protruded  pile,  the  usual  anal  pouches  or  sacs  are  much 
enlarged,  and  have  their  orifices  pointing  downwards.  The  awl  when  placed 
as  intended,  is  between  these  sacs  and  the  adjoining  margin  of  the  anus,  and 
makes  the  part  so  firm,  that  it  is  more  easily  operated  on  subsequently.  The 
inferior  third  of  the  base  of  the  tumour  is  now  detached  from  the  anus 
with  a  scalpel,  the  anal  sacs,  and  a  corresponding  loose  fold  of  skin  which 
commonly  exists  at  the  same  time  with  large  hemorrhoids,  going  along  with 
the  tumour.  Should  the  tumour  recede,  the  loop  above,  and  the  awl  be- 
low, enable  the  operator  to  draw  it  out.  A  wire  noose  is  then  thrown 
around  the  adherent  base  of  the  tumour,  and  drawn  perfectly  tight,  by  the 
aid  of  a  double  canula.     This  noose  occupies  the  previous  incision  and  it 

*  Soe  Horner's  Anut.  vol.  ii.  p.  40,  5th  edition. 


1842.]  Horner's  Treatment  of  Hemorrhoids,  359 

may  be  placed  with  great  accuracy,  from  the  command  over  the  pile  derived 
fiom  the  first  ligature  and  the  awl. 

The  tumour,  if  very  large,  may  now  be  punctured  so  as  to  disgorge  its 
blood.  At  the  end  of  five  hours,  the  part  is  perfectly  dead  by  strangulation^ 
the  tumour  may  then  be  cut  off  near  the  wire  noose,  say  three  lines  from  it, 
for  which  act  in  the  process  of  operating,  a  pair  of  scissors  will  do;  but  what 
is  still  better,  Dr.  Physick's  tonsil  instrument,  owing  to  the  accuracy  of  its 
line  of  incision.  The  wire  noose  itself  may  then  be  taken  away,  as  the 
vessels  are  so  compressed  and  deadened,  that  no  blood  will  pass  through 
them. 

The  awl  should  be  removed  directly  after  the  wire  noose  is  applied  and 
fixed,  but  the  first  loop  should  be  retained  for  the  final  act,  to  wit:  the  exci- 
sion of  the  tumour,  as  it  assists  very  much.  The  operation  thus  completed, 
an  injection  of  tinct.  opii  ^i.  in  two  ounces  of  thin  starch,  puts  the  patient 
at  ease,  and  he  falls  into  a  tranquil  sleep. 

I  have  now  tried  this  combination  of  existing  plans  in  several  cases,  it  has 
the  signal  advantage  of  reducing  pain  and  counteracting  hemorrhage,  and  is 
decidedly  the  best  for  large  piles  that  I  have  seen  used.  The  description  of 
it  is  much  longer  in  time  than  the  operative  process  itself,  which  when  well 
arranged  occupies  but  a  very  few  minutes,  excepting  the  delay  of  the  wire 
loop.  My  confidence  in  it  is  such  that  I  now  undertake  with  but  little 
anxiety,  cases  which  I  formerly  approached  with  dread.  Should  other 
persons  be  tempted  to  adopt  these  rules,  I  trust  that  they  will  find  in  their 
own  experience  a  confirmation  of  mine,  and  be  saved  from  some  of  the  most 
appalling  scenes  in  operative  surgery. 

Where  hemorrhoids  have  existed  several  years,  for  many  persons  submit 
to  them  five,  ten  or  twenty  years,  even  more,  under  a  belief  of  their  in- 
curability, or  of  the  hazard  of  an  operation,  they  will  be  found  complicated 
with  prolapsus  of  the  rectum.  In  such  cases,  there  are  generally  three 
tumours,  one  for  each  side  of  the  anus,  and  a  smaller  one  in  front.  The  judg- 
ment of  the  surgeon  here  must  determine,  whether  he  will  dispose  of  them 
by  one,  two  or  three  distinct  operations,  also  how  much  of  the  mucous  coat 
of  the  rectum  he  will  take  away  with  the  base  of  each  tumour.  No  general 
directions  on  these  points  will  meet  the  exigencies  of  each  individual  case. 
In  the  indurated  or  fig-like  tumour,  which  is  made  almost  wholly  of  coagu- 
lated lymph  like  the  tumours  of  the  labia  interna  of  dissolute  females,  the 
immediate  excision  is  the  best  process.  My  remarks  are  intended  for  the 
vascular  form  of  piles,  by  far  the  most  frequent,  in  my  experience. 

I  will  conclude  by  stating,  that  it  is  of  importance  to  detach  well  by  the 
incision  first  alluded  to,  the  base  of  the  tumour  from  the  internal  sphinctec 
muscle,  without  which  precaution,  we  cut  through  instead  of  lifting  up  and 
remo^ving  a  plexus  of  veins  at  the  anus;  we  also  leave  thereby  unfortunately, 
a  fold  of  tegument  which  swells  and  inflames  largely,  and  the  reduction  of 
which  swelling  gives  rise  to  a  treatment  as  severe  and  protracted  as  a  com- 
mon attack  of  hemorrhoids. 


360  Carr  on  the  Crepitant  Bhonchus.  [Oct. 


Art.  XIII. — Suggestion  as  to  the  Cause  of  the  Crepitant  Rhonchus.     By 
Edson  Carr,  M.  D.,  of  Canandaigua,  N.  Y. 

The  insidious  character  which  pneumonia  occasionally  assumes,  renders 
the  rale  crepitant  of  Laennec,  (the  crepitant  rhonchus  of  Dr.  Williams,  the 
moist  crepitus  rhonchus  of  Copland,  &c.)  worthy  of  the  most  attentive  con- 
sideration, since  it  is  regarded  by  auscultators  as  pathognomonic  of  ihe  first 
stage  of  the  disease,  when,  for  all  the  purposes  of  our  art,  it  is  of  the 
utmost  importance  that  our  diagnosis  should  be  correct. 

The  sound  in  question,  is  described  as  resembling  that  which  may  be  pro- 
duced by  rubbing  a  lock  of  hair  between  the  thumb  and  finger,  when  held 
near  the  ear;  or  that  occasioned  by  the  crackling  of  fine  salt,  when 
thrown  upon  burning  coals.  Dr.  Copland  compares  it  to  the  crepitation 
produced  by  distending  a  piece  of  lung  with  air,  after  it  had  been  com- 
pressed; and  thinks  it  arises  from  the  diminished  calibre  of  the  minute  bron- 
chi, owing  to  interstitial  effusion,  and  admixture  of  respired  air,  with  the 
secreted  or  effused  fluids  in  the  tubes  and  air-cells. 

It  is  generally  supposed  by  auscultators,  that  this  sound  is  caused  by  the 
bursting  of  extremely  small  bubbles  of  mucus  in  the  air  vesicles  and  smallest 
bronchi.  Indeed,  the  latest  writers  upon  this  subject,  class  it  among  what 
they  denominate  the  hullar  relies^  and  M.  Raciborski  in  particular,  makes 
it  depend  on  the  crackling  of  the  bursting  bubbles,  occasioned  by  the  dry 
and  viscid  state  of  the  mucus,  of  which  they  are  composed. 

M.  Beau,  who  has  made  some  very  interesting  and  valuable  observations 
on  auscultation,  dissents  from  the  opinion  commonly  entertained  respecting 
the  cause  of  this  sound,  and  suggests  whether,  if  we  consider  that  it  is  not 
at  all  modified  after  a  fit  of  coughing,  and  also  that  it  is  distinctly  perceptible 
in  many  cases  of  pneumonia,  before  any  expectoration  takes  place,  it  does 
not  more  probably  depend  on  the  friction  of  the  pulmonary  vesicles,  which, 
like  the  pleura,  pericardium,  and  synovial  membranes,  are  probably  some- 
what dried  (dessechees)  by  the  existing  inflammatory  action. 

Admitting  that  the  considerations  adduced  by  M.  Beau,  appear  to  consti- 
tute a  sound  objection  to  the  commonly  received  opinion  on  this  subject,  we 
may  still  be  allowed  to  inquire,  if  the  views  which  he  has  offered  as  a  sub- 
stitute, are  not  equally  unsatisfactory. 

If  the  sound  in  question  were  occasioned  by  the  bursting  of  minute  bub- 
bles of  mucus,  it  ought,  like  the  mucus  and  submucous  rales,  to  continue 
through  expiration,  since  it  is  here  that  the  bullar  rales  are  most  distinct. 
But  every  practical  auscultator  is  aware  that  while  it  (the  rale  crepitant)  con- 
tinues uniform  quite  to  the  end  of  inspiration,  it  is  suddenly,  and  entirely 
suspended  at  the  commencement  of  expiration. 

That  the  bullar  rales  should  be  heard  most  distinctly  during  expiration. 


1842.]  Carr  on  Crepitant  Bhonchus,  361 

will  appear  very  obvious,  when  we  consider  the  admirable  arrangement  pro- 
vided for  clearing  the  air  passages  of  the  bronchial  secretions,  and  prevent- 
ing them,  as  well  as  all  foreign  matters  inhaled,  from  gravitating  towards  the 
air  vesicles. 

From  the  experiments  of  Sir  Charles  Bell,  and  others,  it  is  evident,  that 
the  transverse  bronchial  muscles  act  in  opposition  to  the  elasticity  of  the 
cartilaginous  rings,  which  enter  into  the  formation  of  the  bronchial  tubes, 
and  that  during  insph^ation,  these  muscles  are  relaxed,  so  as  to  allow  the 
air  passsges  to  expand  through  their  whole  extent.  The  effect  of  this  sim- 
ple arrangement  is  to  allow  the  air  a  free  passage  to  the  air-vesicles,  without 
disturbing  the  mucous  with  which  these  passages  are  lubricated,  but  during 
expiration  these  muscles  are  called  into  action,  the  calibre  of  the  tubes  is 
diminished,  the  air  is  consequently  expelled  with  greater  impetus,  the  secre- 
tions occupying  a  greater  proportion  of  the  calibre  of  the  tubes,  are  pushed 
forwards  until  they  accumulate  in  the  larynx,  causing  sufficient  irritation  to 
provoke  a  powerful  expulsive  effort,  or  cough,  and  are  thrown  off.  Where 
the  secretions  are  abundant,  as  in  the  later  stages  of  pneumonia  and  bron- 
chitis, the  free  passage  of  the  air  is  partially  obstructed,  and  more  especially 
during  expiration,  when  the  tubes  are  most  contracted.  These  secretions 
are  consequently  thrown  into  agitation,  the  air  mingling  with  them,  forms 
numerous  bubbles,  the  bursting  of  which,  gives  rise  to  the  louder  bullar 
rales. 

But  a  very  different  state  of  things  exists  in  the  early  stage  of  pneumonia, 
where  the  crepitant  rale  is  heard. 

I  believe  M.  Beau  and  Dr.  Williams  are  quite  correct  in  supposing  that 
the  bronchial  membranes  are  somewhat  dried  by  the  existing  inflammatory 
action,  since  one  of  the  most  manifest  chancres  observed  durinof  the  early 
stages  of  pneumonia,  is  a  suspension  of  the  aqueous  exhalation  from  the  bron- 
chial membranes.  Now,  the  suspension  of  this  function  necessarily  leaves  the 
mucous  with  which  the  air-passages  are  lubricated,  in  so  thick  and  tenacious 
a  condition,  that  these  membranes  are  glued  together  whenever  they  come 
in  contact.  The  pulmonary  tissue  being  more  or  less  compressed  by  the 
descent  of  the  ribs,  and  the  rising  of  the  diaphragm  during  every  expiration, 
the  bronchial  membranes  are  to  a  greater  or  less  extent  forced  into  direct  con- 
tact. The  capillary  congestion  and  interstitial  effusion,  which  are  among  the 
essential  elements  of  pneumonia,  must  greatly  increase  the  volume  of  the  dis- 
eased lung,  and  consequently  augment  the  compression  of  the  pulmonary 
tissue,  and  facilitate  the  adhesion  or  gluing  together  of  the  bronchial  vesicles. 

Now,  dunng  every  inspiration,  the  air  rushing  into  and  distending  these 
vesicles,  necessarily  overcomes  these  cohesions.   And  would  not  the  separat- 
ing of  these  membranes  thus  glued  together  by  tenacious  mucus,  naturally 
produce  precisely  such  sounds  as  constitute  the  crepitant  rale  of  pneumonia? 
'    If  this  view  of  the  phenomena  be  correct,  it  is  not  strange  that  "  distending 
No.  VlII.-^OcTOBER,  1842.  31 


362  Hildreth  on  Creasote  in  Diseases  of  the  Eye.  [Oct. 

a  piece  of  lung  with  air  after  it  has  been  compressed,"  should  give  rise  to  a 
similar  rale. 

A  great  variety  of  experiments  might  here  be  introduced,  to  illustrate  this 
view  of  the  phenomena.  One  of  the  most  simple,  is  that  of  moistening  the 
thumb  and  finger  with  very  thick  paste,  or  mucilage  of  gum  arable,  and 
alternately  pinching  them  together  and  separating  them  when  held  near  the 
ear. 

By  repeating  and  modifying  this  simple  experiment,  sounds  may  be  pro- 
duced so  perfectly  imitating  the  crepitant  rale  of  pneumonia,  that  I  am  per- 
suaded that  no  one  who  will  take  the  trouble  to  try  it,  will  doubt  this  expla- 
nation of  its  cause. 

To  those  who  have  bestowed  but  little  attention  to  the  subject  of  the  phy- 
sical signs  of  disease,  such  inquiries  may  appear  of  little  consequence.  But 
the  careful  and  experienced  auscultator  will  appreciate  the  following  senti- 
ment of  the  author  of  one  of  the  best  works  on  diseases  of  the  chest,  that 
has  appeared  in  the  English  language. 

*'I  have  ever  found  in  practice,  and  it  is  perfectly  conformable  to  reason, 
that  the  easiest  and  most  agreeable  way  to  study  physical  signs,  and  to 
attain  the  surest  criterion  of  their  value  and  importance,  is  by  considering 
hoiv  they  are  caused,  or  what  are  the  relations  in  which  they  stand  to  the 
physiological  and  pathological  states  that  produce  them." 

Canandaigi/a,  Aug.  20,  1842. 


Art.  XIV. — On  Creasote  in  diseases  of  the  Conjunctiva  and  Cornea,    By 
Chas.  C.  Hildreth,  M.  D.,  of  Zanesville,  Ohio. 

Creasote  has  for  many  years  been  found  a  most  efficient  remedy  in  disease 
of  the  mucous  and  dermoid  tissues.  It  has  been  precribed  with  good  effect  in 
ulceration  of  the  mucous  membrane  of  the  mouth,  ear,  and  nose;  in  foul  or 
sloughing  ulcers  of  the  skin,  and  in  various  cutaneous  diseases.  It  has 
been  found  valuable  in  the  arrest  of  haemorrhage,  in  rheumatism,  in  odon- 
talgia, in  nausea  and  vomiting  of  a  certain  character,  &c.  &c. 

Its  properties  are  said  to  be  stimulant,  astringent,  and  antiseptic.  As 
most  of  the  topical  applications  for  disease  of  the  external  tunics  of  the  eye 
are  of  a  somewhat  similar  character,  I  was  led  from  analogy  to  its  use  in 
such  cases.  And  as  its  sanative  and  healing  influence  is  obvious  and  gene- 
rally acknowledged  in  ulceration  of  other  mucous  membranes,  I  was  led  to 
expect  something  from  its  use  in  similar  disease  of  the  eye. 

In  the  year  1836,  in  a  case  of  opacity  of  the  cornea,  the  result  of  scro- 
fulous ophthalmia,  I  first  prescribed  the  creasote  in  disease  of  the  eye. 


1842.]  Hildreth  on  Cr'easote  in  Diseases  of  the  Eye.  36lf" 

The  patient  was  a  little  girl  of  about  six  years,  the  daughter  of  Dr.  Parker, 
residing  ten  miles  from  Zanesville.  She  had  been  suffering  from  inflamma- 
tion of  a  strumous  character,  in  both  eyes,  for  three  or  four  years;  for  which 
she  had  been  very  injudiciously  treated  by  some  neighbouring  practitioner, 
by  an  active  and  long  continued  antiphlogistic  course. 

When  brought  to  me,  she  presented  the  appearance  of  extreme  exhaustion, 
was  very  pale  and  emaciated;  and  had  all  the  usual  marks  of  the  scrofu- 
lous diathesis. 

I  need  not  say  to  an  oculist,  that  under  such  a  course  of  treatment,  she 
became  almost  entirely  blind. 

The  cornea  of  each  eye  was  of  a  pearl  white,  interspersed  with  red  ves- 
sels, which  ramified  in  all  directions  over  its  surface;  and  even  the  termina- 
tions of  those  larger  fasciculi  which  were  very  apparent  over  the  sclerotic. 

There  were  also  numerous  small  ulcerations  over  the  surface  of  each  cor- 
nea. Notwithstanding  the  opacity,  her  eyes  were  very  sensitive  to  light; 
compelling  her  to  wear  a  shade  when  exposed  to  the  sun,  or  bury  her  face 
in  a  pillow  when  lying  down  during  the  day. 

The  usual  treatment  of  this  variety  of  disease  was  promptly  enforced; 
alterative  cathartics  were  given;  and  as  worms  were  found  to  be  present, 
the  usual  means  for  their  destruction  and  expulsion  were  adopted,  and  with 
the  desired  effect.  As  soon  as  the  secretions  from  her  bowels  became 
healthy,  she  was  put  upon  a  course  of  tonics,  so  evidently  demanded  by  her 
exhausted  and  anemic  condition. 

The  precipitated  carbonate  of  iron,  and  sulphate  of  quinine,  were  given  in 
large  doses:  a  more  liberal  diet  of  animal  food  allowed;  exercise  in  the  open 
air,  and  the  daily  use  of  the  saline  bath,  followed  by  vigorous  frictions  of 
the  whole  cutaneous  surface  enjoined. 

Under  this  course  of  treatment,  the  eye  became  less  intolerant  of  light, 
and  the  general  health  and  strength  rapidly  improved. 

The  usual  local  applications  were  then  made  to  the  eyes:  the  nitrate  of 
silver  applied  in  substance  to  the  ulcerations,  and  in  solution  as  a  colly- 
rium,  in  the  strength  of  four  grains  to  the  ounce  of  distilled  water. 

The  red  precipitate  ointment  at  night,  to  the  edge  of  the  eyelids,  to  cor- 
rect some  disease  of  the  meibomian  follicles.  The  upper  eyelids  were  fre- 
quently everted  and  scarified;  and  as  the  conjunctiva  was  found  slightly 
granular,  its  surface  was  touched  every  two  or  three  days  with  sulphate  of 
copper  or  nitrate  of  silver. 

Some  of  the  larger  blood-vessels  over  the  sclerotic,  which  obviously  ter- 
minated in  the  ulcerations  of  the  cornea,  were  taken  up  by  a  hook  and 
divided;  as  has  been  advised  by  the  best  authorities.  From  these  little  ope- 
rations, however,  I  am  confident  my  patient  derived  more  injury  than  bene- 
fit, on  account  of  the  inflammation  which  followed.  There  appears  to  be  so 
much  irritability  about  a  scrofulous  eye,  as  to  render  it  peculiarly  unfit 
for   the  knife;  this,  in  connection  with  the  free  and  perfect  anastomosis 


364  Hiklreth  on  Creasote  in  Diseases  of  the  Eye.  [Oct. 

between  the  larger  fasciculi  under  the  adnata,  renders  the  taking  up  of  one 
or  two  of  them  of  but  little  avail,  so  far  as  I  have  observed,  in  subduing  mor- 
bid action.  For  these  reasons,  I  have  not  for  some  years  past,  attempted 
the  reduction  of  scrofulous  vascular  albugo  or  nebula,  by  surgical  means; 
but  have  relied  upon  milder,  and  I  have  reason  to  believe,  more  ejfficient 
remedies. 

Notwithstanding  the  careful  observance  of  the  above  plan  of  treatment, 
my  patient's  improvement  of  vision  was  scarcely  perceptible.  At  the  end  of 
three  weeks,  there  was  less  intolerance  of  light,  her  general  health  much 
better,  her  appetite,  flesh  and  strength  rapidly  returning. 

The  opacity  and  vascularity  of  the  cornea,  still  however  persist.  Some 
few  ulcers  are  yet  visible  over  its  surface.  To  these  the  caustic  was  applied 
every  third  day  in  substance;  and  that  the  whole  excavated  surface  of  the 
ulcer  might  be  fairly  touched,  it  was  applied  in  powder.  This  was  readily 
effected  by  touching  the  sharp  point  of  a  pencil  of  lunar  caustic,  slightly 
moistened,  to  a  little  pulverised  nitrate  (to  which  it  readily  adheres)  and  thus 
applying  it  to  the  ulcer;  by  this  means  we  secure  a  perfect  and  instantaneous 
application  of  the  remedy  to  the  whole  diseased  surface.  Counter-irritation 
by  blisters  and  tartar  emetic  was  also  directed  to  the  back  of  the  neck,  and 
behind  the  ears. 

At  the  expiration  of  four  weeks  my  patient  returned  to  the  country,  very 
much  against  my  wishes. 

The  tonic  course  of  treatment  was  still  directed,  also  exercise  in  the  open 
air,  with  the  eyes  protected  by  folds  of  green  gauze,  if  intolerant  of  light;  the 
local  remedies  to  be  continued. 

About  ten  days  from  this  time,  the  father  of  the  child  came  again  to  con- 
sult me.  Vision  was  but  slightly  improved;  the  cornea  still  opaque,  and 
vascular. 

The  remedies  appeared  to  have  lost  their  influence,  and  the  extreme 
repugnance  of  the  child  to  the  caustic,  had  compelled  them  to  abandon  it.  I 
then  prescribed  the  strong  mercurial  ointment,  half  an  ounce,  to  be  intimately 
combined  with  fifteen  drops  of  creasote.  A  small  portion  of  this  to  be  intro- 
duced under  the  upper  eyelid  when  drawn  ofl*  from  the  globe,  and  then 
brought  in  contact  with  the  cornea,  and  rubbed  over  the  whole  conjunctival 
surface;  to  be  repeated  morning  and  evening.  This  prescription  had  a 
much  better  effect  than  any  previously  in  use. 

During  the  first  week  of  its  use,  there  was  a  perceptible  improvement  of 
vision.  The  efl'used  lymph  under  the  conjunctival  covering  of  the  cornea, 
or  between  its  lamina,  began  to  be  absorbed;  the  enlarged  vessels  under  the 
strong  astringency  of  the  remedy,  began  to  diminish  in  calibre,  until  under 
its  continued  use  they  disappeared  entirely.  This  combination  was  conti- 
nued for  two  months,  occasionally  adding  a  few  drops  of  creasote,  to  main- 
tain its  strength.  At  the  expiration  of  this  time,  all  trace  of  inflammation 
or  ulceration  had  disappeared  from  the  eyes;  but  the  patient  was  found  very 


.1842.]  Hildreth  on  Creasote  in  Diseases  of  the  Eye.  3Q5 

near-sighted.     Concave  glasses  have,  however,  in  a  great  measure  overcome 
this  defect. 

Did  the  limits  of  this  paper  permit,  many  other  cases  of  scrofulous 
ophthalmia,  both  acute  and  chronic,  might  be  cited,  which  were  promptly 
cured  by  the  creasote.  As  we  have  prescribed  little  else,  as  a  topical 
application  in  strumous  cases,  for  several  years,  we  can  speak  positively 
as  to  its  efficacy,  when  combined  with  the  proper  constitutional  treatment. 
As  creasote  is  acknowledged  to  be  one  of  our  best  remedies  in  various  erup- 
tive diseases,  as  well  as  ulceration  of  the  external  integuments,  and  mucous 
membranes,  we  should  naturally  expect  some  advantage  from  its  use  in 
scrofulous  ophthalmia.  For  in  this  disease  also,  we  have  usually  a  distinct 
pustular  eruption,  succeeded  by  ulceration. 

Perhaps  it  may  not  be  amiss  to  remark  here,  that  a  mistake  is  very  often 
committed  by  those  who  have  not  devoted  much  attention  to  disease  of  the 
eye,  in  attempting  the  cure  of  scrofulous  ophthalmia  by  topical  applications 
alone,  or  wliat  is  still  more  unpardonable,  by  rigid  antiphlogistic  treatment. 
Thousands  of  eyes  have  been  sacrificed  to  a  most  culpable  ignorance  on  this 
subject.  Common  sense,  and  common  observation  should  teach,  that  the 
local  affection  cannot  be  successfully  attacked,  without  first  overcoming  the 
constitutional  disease.  Mistakes  of  this  kind  are  the  more  inexcusable,  as 
the  diagnosis  is  exceedingly  simple. 

In  all  cases  of  scrofulous  ophthalmia,  whether  acute  or  chronic,  we  have 
found  the  creasote  a  most  effective  remedy,  in  connection  with  the  proper 
constitutional  treatment.  It  should  be  applied  to  the  eye  of  such  a  strength, 
that  the  burning  or  smarting  pain  from  it  shall  not  continue  more  than  Jive 
minutes  after  its  introduction.  If  much  inconvenience  is  felt  from  it  for  a 
longer  period,  the  ointment  containing  it  must  be  diluted  with  simple  cerate, 
or  fresh  lard  perfectly  pure. 

The  more  chronic  the  case,  the  more  creasote  will  be  required  and  borne. 
My  usual  prescription  is  from  ten  to  thirty  drops  to  the  ounce  of  strong  mer- 
curial ointment;  more  than  this  may,  perhaps,  be  required  in  some  very 
chronic  cases,  where  the  eye  has  become  somewhat  insensible  from  long 
continuance  of  active  stimulants.  Should  the  remedy  prove  too  irritating, 
frequent  bathing  the  eye  with  warm  milk  and  water,  or  the  introduction  of 
a  few  drops  of  cold  cream  into  the  inner  canthus,  will  soon  destroy  its  efifect. 

As  creasote  evaporates  rapidly,  the  ointment  must  be  kept  air  tight,  other- 
wise a  few  drops  must  occasionally  be  added  to  preserve  its  relative  strength. 

One  decided  advantage  of  the  creasote  over  caustic  in  scrofulous  ulceration 
of  the  cornea,  is  its  facility  of  application.  The  ointment  can  be  introduced 
under  the  eyelid,  ancj  rubbed  over  the  whole  globe,  when  it  would  be  found 
impossible  to  persuade  the  child  to  submit  to  the  repeated  application  of  the 
caustic  in  substance  to  each  separate  ulceration  or  opacity.  We  believe, 
also,  that  it  will  be  found  more  efficacious  in  reducing  vascularity,  promot- 
ing absorption,  and  healing  ulceration  if  applied  of  the  proper  strength. 

31* 


366  Hildreth  on  Creasote  in  Diseases  of  the  Eye,  [Oct. 

As  disease  of  the  meibomian  follicles,  or  ophthalmia-tarsi,  is  almost  inva- 
riably present  in  cases  of  scrofulous  ophthalmia,  the  creasote  ointment  will 
prove  a  most  excellent  remedy  for  this  complication.  For  this  purpose, 
however,  we  have  found  its  combination  with  red  precipitate  ointment  a  bet- 
ter preparation. 

When  psorophthalmia  is  of  a  very  chronic  character,  we  have  no  substi- 
tute for  the  pencil  of  nitrate  of  silver,  applied  directly  to  the  diseased  fol- 
licles. 

Granular  conjunctiva  is  another  disease  of  the  eye,  which  is  very  fre- 
quently overlooked  by  the  general  practitioner.  This  is  the  more  unfortu- 
nate, as  it  is  a  disease  of  very  frequent  occurrence.  It  will,  no  doubt,  be 
found,  on  careful  examination,  that  a  large  majority  of  the  cases  of  vascular 
albugo,  or  nebula,  of  a  chronic  character,  are  either  produced  or  perpetuated 
by  this  lesion. 

Notwithstanding  its  frequency,  I  have  known  the  most  respectable  practi- 
tioners treat  cases  of  opacity  of  the  cornea,  accompanied  by  this  change  of 
structure,  for  months  and  years,  without  ever  everting  the  upper  eyelid. 

The  treatment  consists  in  the  removal  with  the  knife,  of  vascular  excres- 
cences, or  the  surface  of  the  conjunctiva  itself,  if  very  exuberant:  frequent 
scarifications,  and  touching  the  whole  diseased  surface  every  two  or  three 
days,  with  nitrate  of  silver,  or  sulphate  of  copper  in  substance,  counter-irri- 
tation by  tartar  emetic,  or  blisters,  &c. 

The  preparation  of  creasote,  and  blue  ointment,  or  in  combination  with 
red  precipitate  ointment,  (if  the  case  be  very  chronic),  will  also  be  found  a 
most  valuable  adjuvant.  The  strong  astringency  of  the  creasote,  will  tend 
to  reduce  the  increased  vascularity  of  the  surface,  while  the  mercurial  will 
materially  assist  in  the  reduction  of  enlarged  glands  and  follicles. 

Should  vascular  albugo  or  nebula  accompany  the  diseased  membrane,  its 
stimulant,  astringent,  and  sorbifacient  virtues,  will  prove  still  more  valuable. 
It  should  be  applied  in  the  manner  before  directed  in  scrofulous  ophthal- 
mia; and  continued  until  the  mucous  surface  becomes  smooth  and  polished. 
If  we  stop  short  of  this,  the  eye  will  be  left  very  irritable,  and  any  exposure 
will  tend  to  reproduce  the  disease,  with  its  accompanying  inflammation,  and 
opacity.  We  have  also  found  the  creasote  applicable  to  many  of  the  dis- 
eases of  the  conjunctiva,  and  cornea;  for  which  the  nitrate  of  silver  is  the 
standing  prescription  of  the  best  authors.  In  simple  inflammation  of  the 
conjunctiva,  or  puro-mucous  conjunctivitis,  we  have  not  prescribed  it,  until 
the  inflammatory  symptoms  have  yielded  to  antiphlogistic  and  other  reme- 
dies. In  puro-purulent  ophthalmia,  however,  it  may  be  used  earlier,  in  con- 
junction with  the  active  constitutional  treatment  advised  in  the  books. 

In  these  cases,  however,  we  are  not  aware  that  the  advantages  to  be  de- 
rived from  its  use,  will  exceed  those  of  other  topical  applications  of  estab- 
lished efficacy. 

In  the  scrofulous  eruptive  disease  of  the  cornea,  in  vascular  opacity,  and 


1842.]       Davis's  Case  of  Chronic  Enlargement  of  the  Spleen.  367 

superficial  ulceration,  we  have  found  it  a  decidedly  better  remedy  than  the 
nitrate  of  silver;  but  in  dense  opacity,  or  leucoma,  and  in  deep  penetrating 
nicer,  when  we  fear  perforation  of  the  cornea,  and  escape  of  the  aqueous 
humour,  we  believe  the  nitrate  in  substance  the  better  application. 

In  many  of  the  chronic  diseases  of  the  external  tunics,  we  are  in  the 
practice  of  combining  the  use  of  the  nitrate  and  creasote,  with  most  excel- 
lent results. 

In  fine,  we  are  quite  confident  the  creasote  will  prove  a  very  valuable  addi- 
tion to  our  stock  of  remedies  for  diseases  of  the  eye. 


Art.  XV. — Chronic  Enlargement  of  the  Spleen.    By  N.  S.  Davis,  M.  D., 

f  of  Binghamton,  N.  Y. 

Was  called  to  see  Mrs.  W ,  aged  47  years,  a  few  days  before  her 

death.  She  was  naturally  a  strong,  healthy,  labouring  woman.  Found  her 
very  much  emaciated;  countenance  bloated,  with  an  expression  of  sufliering 
and  anxiety;  pulse  95  per  minute,  and  feeble;  frequent  nausea,  and  sometimes 
vomiting;  bowels  inactive;  tongue  covered  with  a  slight  yellow  fur  in  the 
middle;  much  thirst,  and  little  appetite.  On  examining  the  abdomen,  a  hard, 
and  apparently  indolent  tumour  was  found,  occupying  the  whole  left  hypo- 
chondriac region,  from  the  diaphragm  to  the  os  ilium,  and  from  the  left 
side  of  the  spinal  column  to  the  right  side  of  the  epigastric  region;  thence 
downward  on  the  right  side  of  the  umbilicus,  to  within  one  inch  of  the  os 
ilium  of  the  right  side. 

Its  pressure  against  the  stomach  and  diaphragm  often  causes  much  diffi- 
culty of  breathing,  and  a  great  sense  of  weight  and  sinking  in  the  epigas- 
trium and  left  side.  There  was  very  little  tenderness  to  the  pressure  except 
in  a  few  circumscribed  places  of  small  extent.  She  had  some  night  sweats, 
and  was  evidently  labouring  under  a  mild  grade  of  irritative  or  hectic  fever. 
The  same  symptoms  continued  gradually  increasing  in  severity,  until  the 
stomach  would  no  longer  retain  any  considerable  nourishment,  and  the 
patient  died  comatose  on  the  23d  of  May,  1842. 

Post  mortem  examination  twenty  four  hours  after  death. — On  opening  the 
abdomen  in  the  usual  way,  a  large,  firm,  fleshy  mass  presented  itself,  filling  all 
the  left  hypochondriac  and  iliac  regions,  and  more  than  two-thirds  of  the 
epigastric,  and  umbilical  regions.  It  was  enclosed  in  a  complete  sac  of 
dense  cellular  tissue;  which  in  many  places  was  highly  injected  with  blood, 
and  slightly  adhered  to  the  surface  of  the  enlarged  viscus.  On  laying  open 
and  removing  this  sac,  the  surface  of  the  spleen  appeared  covered  by  its  peri- 
toneal coat;  colour  rather  darker  than  natural,  except  in  three  or  four  places 


368  Shanks'  Case  of  Gelatinous  Polypus.  [Oct. 

of  small  extent,  where  it  appeard  the  colour  of  charcoal,  from  the  tissue 
beneath  being  melanosed  or  filled  with  a  black  substance.  The  blood-vessels 
were  enormously  large,  and  the  substance  of  the  organ  very  firm;  and  more 
or  less  engorged  with  dark  blood  throughout.  It  was  12  inches  in  length, 
19  in  circumference,  and  weighed  eight  pounds  and  ten  ounces,  without  the 
sac  which  surrounded  it.  The  only  appearances  of  active  inflammation,  were 
on  the  under  surface  of  the  sac,  and  where  it  came  in  contact  with  the  arch 
of  the  colon. 

The  stomach  was  unusually  pale  in  its  external  appearance;  and  its  pyloric 
orifice  considerably  thickened  and  contracted. 

All  the  other  viscera  appeared  normal.  No  cause  could  be  assigned  for  the 
commencement  of  the  morbid  action  in  the  spleen,  which  was  first  observed 
about  four  years  previous  to  the  patient's  death. 

BiNGHAMTON,  N.  Y.,  Juifie  24^/t,  1842. 


Art.  XVI. — Case  of  Gelatinous  Polypus,  cured  with  Sanguinaria  Cana- 
densis after  extraction  had  twice  failed.  By  Lewis  Shanks,  M.  D.,  of 
Memphis,  Tennessee. 

In  August  1840,  I  extracted  a  polypus  from  the  nose  of  a  young  lady, 
which  projected  into  the  nostril,  and  hung  down  into  the  throat,  so  as  to 
obstruct  the  nostril,  and  produce  considerable  difficulty  in  breathing  and 
swallowing.  When  extracted,  which  was  done  through  the  mouth,  it  was 
found  to  be  a  tenacious,  membranous  sac,  filled  with  a  straw-coloured  gela- 
tinous fluid,  attached  by  a  small  neck  to  the  upper  part  of  the  posterior  nasal 
surface.  The  sac  had  gradually  expanded  forward  into  the  nostril,  and 
downwards  into  the  throat,  conforming  its  shape  and  size  to  those  passages, 
until  the  posterior  portion  had  become  as  large  as  a  hen's  egg,  and  the  nasal 
portion  somewhat  less,  when  it  was  extracted.  No  symptoms  of  a  return 
of  the  polypus  occurred  until  the  next  spring  about  the  time  of  its  first  com- 
mencement. The  yellow  puccoon  root,  not  having  the  red,  was  tried,  but  the 
polypus  continued  to  enlarge.  After  acquiring  considerable  size,  it  several 
times  broke,  and  discharged  its  gelatinous  contents.  In  July  1841,  I  extract- 
ed it  again,  when  it  was  found  to  have  a  much  broader  surface  of  attachment 
to  the  nasal  membrane. 

Last  spring,  early  in  April,  about  the  same  time  the  first  symptoms  had  been 
felt  the  two  previous  years,  it  commenced  again.  About  a  month  afterwards, 
when  it  had  become  so  large  as  almost  to  obstruct  the  nostril,  I  procured 
some  of  the  sanguinaria  canadensis  finely  powdered,  and  caused  it  to  be 
snuffed  up  the  nostril,  and  the  throat  to  be  gargled  with  a  strong  infusion.  In 


1842.]         Neill's  Case  of  Spontaneous  Rupture  of  the  Spleen,  369 

less  than  twenty-four  hours  after  the  frequent  use  of  this  was  commenced,  it 
broke,  discharging  a  considerable  quantity  of  gelatinous  fluid.  The  remedy 
was  continued,  until  the  whole  inner  surface  of  the  nostril  was  made  raw, 
and  occasionally  afterwards  used.  The  sac  did  not  fill  again,  and  all  the 
symptoms  were  soon  entirely  removed. 

The  cure  is  now  believed  to  be  perfect.  If,  however,  the  symptoms 
should  return  again  next  spring,  this  remedy  promises  a  certain  and  speedy 
cure  in  the  commencement,  before  the  sac  becomes  large. 

Memphis,  Tenn.,  June,  1842. 


Art.   XVII. — Case  of  Spontaneous  Bupture  of  the   Spleen.     By  Johm 

Neill,  M.D. 

Wm.  Wray,  a  black  seaman,  aetat.  42,  sent  for  me  at  5  o'clock  in  the 
afternoon.  He  appeared  to  have  a  chronic  gastric  affection,  and  gave  this 
account  of  himself. 

He  had  been  a  ship's  steward,  and  was  not  well  on  his  passage  home;  his 
diet  had  consisted  of  pastry,  and  such  delicacies  as  the  cabin  of  the  ship 
afforded;  his  appetite  had  not  been  good,  and  he  had  taken  one  dose  of  salts 
which  was  of  benefit  to  him. 

He  had  been  on  shore  one  month  when  I  saw  him,  during  which  time  he 
had  eaten  but  little,  and  was  very  costive;  he  had  a  constant  dull  pain,  and 
uneasy  sensation  about  the  pit  of  his  stomach,  and  desired  stimulating  food. 
After  eating  he  felt  a  little  better,  but  soon  had  pain,  and  almost  always 
vomited.  The  port  he  sailed  from  was  New  Orleans,  where  he  was  quite 
well  he  thought,  but  previously  had  been  very  ill  at  Maracaibo,  where  many 
of  the  crew  had  died  of  fever. 

I  found  him  lying  on  his  back  with  anxious  countenance,  good  pulse,  no 
fever;  tongue  pale,  and  somewhat  furred;  no  thirst,  bad  taste,  and  with  great 
sense  of  heaviness  and  oppression  at  his  stomach;  he  had  no  passage  for 
several  days. 

Upon  learning  that  he  had  paid  his  hospital  money,  I  advised  him  to  go 
there  and  be  treated;  in  the  meantime  I  directed  an  injection,  and  prescribed 
some  powders  of  calomel,  rhubarb,  and  soda. 

On  the  morning  of  Friday,  I  called  to  see  if  he  had  gone  to  the  hospital, 
and  found  him  dead,  I  was  much  surprised,  and  inquired  as  to  his  condi- 
tion, from  the  time  I  left  him,  on  the  afternoon  before.  His  wife  told  me 
that  he  had  made  no  complaint,  and  had  taken  one  powder;  he  seemed  to 


370  Neill's  Case  of  Spontaneous  Rupture  of  the  Spleen,  [Oct. 

grow  weaker  and  weaker,  until  5  o'clock  A.  M.,  when  he  had  a  slight  con- 
vulsion, affecting  the  muscles  of  the  hands  and  face,  and  afterwards  died 
very  easily. 

I  placed  the  remaining  powder  in  my  pocket  for  analysis,  and  requested  a 
post  mortem  examination. 

Autopsy,  eleven  hours  after  death. — The  expression  of  his  face  was  calm 
and  natural;  the  contents  of  the  thorax  were  perfectly  healthy,  the  lungs 
collapsed.  The  abdomen  was  filled  with  blood  and  clots.  All  of  the  abdo- 
minal viscera,  their  peritoneal  covering,  attachment,  and  vessels,  were  in  a 
normal  condition,  with  the  exception  of  the  spleen.  Here  the  peritoneum 
was  loosened  and  ruptured  in  several  places,  and  the  subjacent  cellular  tissue 
infiltrated  with  clots  of  blood.  The  phrenic,  colic,  and  gastric  omenta,  also 
contained  large  clots  of  blood.  The  spleen  itself  was  of  natural  size  and 
shape,  its  colour  was  darker  than  usual,  and  its  structure  exceedingly  soft, 
so  soft  that  it  could  be  broken  up  by  two  fingers;  we  could  not  determine 
precisely  whether  the  hemorrhage  was  from  the  spleen  itself,  or  from  the 
veins  proceeding  from  it,  during  the  great  infiltration  of  the  parts,  and  their 
not,  being  injected,  but  the  spleen  being  so  very  pulpy,  we  are  inclined  to 
believe  it  was  from  the  organ  itself. 

I  have  found  but  few  cases  on  record  of  death  from  hemorrhage  of  the 
spleen,  and  these  were  the  results  of  external  violence,  with  the  exception 
of  one  case  related  in  the  April  No.  1842,  of  the  "  Journal  des  Commais' 
sances  Medico-Chirurgicales.^'' 

The  subject  of  this  case  was  an  old  soldier  by  the  name  of  Cheure,  a  tender 
of  cows  near  one  of  the  forts  at  Algiers,  who  suddenly  fell  down,  rolled  into 
a  bush,  and  expired.  The  authorities  suspecting  violence,  ordered  an  exami- 
nation of  the  body.  They  learned  that  previous  to  his  death,  he  had  great 
difficulty  of  breathing,  was  unable  to  make  any  great  exertion,  that  his  abdo- 
men was  very  large,  particularly  on  the  left  side,  and  that  he  had  had  intermit- 
tent fever  for  a  long  time.  The  contents  of  his  thorax  were  collapsed,  and 
exsanguine.  His  abdomen  was  distended  as  in  a  severe  ascites,  and  when 
punctured,  an  enormous  quantity  of  blood  escaped.  The  viscera,  with  the 
exception  of  the  spleen,  presented  nothing  remarkable  in  their  appearance. 
The  form  and  size  of  this  organ  were  very  extraordinary.  In  length  it  ex- 
tended from  the  sixth  rib  to  within  a  short  distance  of  the  pubis;  and  in 
breadth,  to  beyond  the  linea  alba. 

The  splenic  artery  was  about  the  size  of  a  goose-quill,  and  the  vein  four 
or  five  times  as  large.  On  its  anterior  surface  was  a  vent,  two  inches  long, 
twelve  lines  wide.  Its  internal  structure  presented  numerous  cells,  large 
enough  to  receive  the  end  of  a  director.  The  hypertrophied  condition  of 
the  spleen  was  undoubtedly  occasioned  by  the  repeated  attacks  of  fever, 
which  likened  his  spleen  in  some  respects  to  a  varicose  aneurism;  a  rupture 
in  which  was  considered  quite  a  sufficient  cause  for  his  death. 


1842.]  Hays'  Operation  for  Artificial  Pupil.  ^11 

In  the  American  Journal  there  are  recorded  six  cases  of  death  produced 
by  rupture  of  the  spleen  in  consequence  of  violence.  One  case  in  vol.  6, 
for  1830,  is  interesting  with  reference  to  medical  jurisprudence.  A  man  in 
a  quarrel  with  his  wife,  struck  her  over  the  spleen  and  she  died.  On  post 
mortem  examination,  her  spleen  was  found  to  have  been  fractured  by  the 
blow,  and  softened  by  intermittent  fever.  In  consequence  of  this  last  cir- 
cumstance he  was  acquitted  of  guilt  in  producing  his  wife's  death. 


Art.  XVIII. — Operation  for  Artificial  Pupil.     By  Isaac  Hays,  M.J., 
Surgeon  to  Wills  Hospital.     (With  three  wood-cuts.) 

John  Kane,  aged  24,  was  admitted  into  Wills  Hospital  in  August,  IHO, 
with  central  opacity  of  both  corneae;  in  the  right  eye  there  was  also  an'^d- 
hesion  of  the  iris  at  the  upper  edge  of  its  pupillary  margin,  to  the  cornea  jist 
above  its  centre;  and  the  pupil  of  the  left  eye  was  closed  by  lymph.     Tlis 
condition  had  resulted  from  an  injury  sustained  whilst  blasting  rocks,  fiv^ 
months   previously.     He   was   subjected   to   the  usual  treatment  for  the 
removal  of  the  opacity  of  the  cornea,  and  of  the  lymph  from  pupil,  and  the 
former  was  so  much  lessened  by  the  following  spring  that  it  was  believed 
useful  vision  might  be  obtained  with  the  left  eye,  if  the  opaque  mass  which 
closed  the  pupil  were  removed.     Extract  of  belladonna  around  the  eye,  and 
mercury  given  to  salivation  having  failed  to  accomplish  this.  Dr.  Fox  with  a 
needle  introduced  through  the  sclerotica  broke  up  the  lymph  and  lens,  and 
after  twice  repeating  the  same  operation,  the  pupil  was  cleared  and  the  patient 
discharged  with  his  sight  much  improved.     In  the  fall  of  1841,  he  applied 
to  be  again  admitted  into  the  hospital,  stating,  that  though  his  sight  was  much 
improved,  it  was  not  good  enough  to  enable  him  to  work  at  his  ordinary 
occupation,  and  begged  that  something  further  might  be  done. 

The  pupil  of  his  left  eye  was  perfectly  clear,  but  the  cloudiness  of  the 
cornea,  considerably  impaired  his  sight. 

This  nebulous  condition  seemed  permanent,  for  it  had  continued  during 
several  months  without  any  improvement,  under  various  applications.  The 
sight  with  this  eye  was  too  good  to  justify  any  operation  upon  it,  as  this 
would  involve  the  risk  of  destroying  what  had  been  gained,  which  the 
chance  for  further  improvement  did  not  justify. 

The  right  eye,  however,  was  in  a  condition  which  seemed  to  authorize  an 
attempt  to  improve  its  power  of  vision.  Sight  with  it  was  so  imperfect  as 
to  be  of  no  use  to  him,  at  least  whilst  he  saw  so  much  better  with  the  other 
eye.     The  lens    was   transparent  and  the    pupil  clear;  there   was  dense 


372  Hays'  Operation  for  Jirtijicial  Pupil,  [Oct. 

opacity  of  the  centre  of  the  cornea,  but  the  lower  portion  was  perfectly 
clear,  excepting  at  a  iew  very  minute  points  where  it  had  been  burned  by 
Fig.  1.  grains  of  gunpowder.     The  upper 

edge  of  the  pupil  adhered,  as  al- 
ready stated,  to  the  cornea.  (See 
Fig.'l.) 

The  pupil  could  be  slightly  di- 
lated with  belladonna  so  as  some- 
what to  improve  the  sight,  but  not 
sufficiently  to  enable  the  patient  to 
see  even  as  well  with  it  as  he  could 
with  the  other  eye.  In  consulta- 
tion with  my  colleagues,  I  therefore 
detemined  to  attempt  an  operation  for  his  relief. 

The  one  which  first  suggested  itself,  as  best  suited  to  this  case,  was  that 
of  Oibson;  but  the  risk  of  wounding  the  anterior  capsule  of  the  lens  with 
the  hook,  and  also  the  danger  of  effusion  of  lymph  from  the  margin  of  the 
indsion  of  the  iris,  rendering  the  capsule  opaque,  and  closing  perhaps  the  new 
pipil,  presented  objections  to  it.  Reflecting  on  the  almost  constant  occur- 
rence of  prolapse  of  the  iris  in  wounds  of  the  cornea  with  consequent 
synechia  anterior  and  drawing  aside  of  the  pupil,  and  that  if  the  pupil  were 
thus  drawn  towards  the  lower  margin  of  the  cornea  by  a  simple  wound  of 
this  coat,  every  thing  that  could  be  desired  would  be  attained,  and  at  little 
risk;  I  decided  to  operate  in  conformity  with  these  views. 

This  I  accordingly  did  on  the  28th  October,  1841,  in  the  presence  of 
my  colleagues,  Drs.  Littell,  Fox  and  Parrish,  the  house  surgeon  Mr.  S.  L. 
Hollingsworth,  and  Drs.  Pepper,  Neill,  &c.  The  patient  being  laid  on  his 
back  on  a  table,  the  lower  lid  of  his  right  eye  was  depressed  by  Dr.  Fox, 
■whilst  I  raised  the  upper  lid  with  the  two  fore-fingers  of  my  left  hand, 
steadying  the  ball  with  the  third  finger.  I  then  with  a  properly  constructed 
cataract  knife  incised  the  cornea  near  its  junction  with  the  sclerotica,  com- 
mencing a  little  below  the  middle  and  extending  so  as  to  divide  nearly  one 
fourth  of  the  circumference  of  the  cornea.  The  knife  was  carried  steadily 
and  ratlier  quickly  forward,  to  prevent  the  escape  of  aqueous  humour  before 
the  completion  of  the  incision,  as  its  sudden  discharge  would  favour  the  pro- 
lapse of  the  iris.  The  moment  the  incision  was  completed  the  knife  was 
withdrawn;  at  the  same  instant  the  aqueous  humour  was  evacuated  at  a  gush, 
and  the  lids  were  allowed  to  close.  The  gush  was  even  greater  than  I  had 
hoped  for,  so  much  so,  that  at  first  I  supposed  some  pressure  must  have 
been  made  on  the  eye,  which  was  not,  however,  the  case.  After  the  lapse 
of  a  minute  or  two,  the  lids  were  separated  and  the  iris  found  prolapsed  so 
as  to  draw  the  lower  edge  of  the  pupil  quite  to  the  incision.  I  felt  satisfied 
that  the  iris  would  adhere  to  the  cornea  at  the  wound,  forming  at  this  point 


1842.]  HenkeVs  Improvement  on  the  Tourniquet.  373 

synechia    anterior,  and    determined  Fig-  2. 

contrary  to  the  opinion  of  all  present 
to  trust  to  this  taking  place.  The 
patient  was  placed  in  a  dark  room, 
and  put  upon  a  restricted  diet.  The 
result  justified  my  confidence;  adhe- 
sion formed,  no  inflammation  oc- 
curred, the  patient  was  soon  able  to 
bear  the  light;  his  vision  improved, 

and   a  few  days    since,  (Sept.    1,)  ^^ 

Kane  called  to  see  me  and  assured 

me  that  his  vision  with  that  eye  was  almost  as  good  as  ever.    The  accom- 
panying figure,  (fig.  2,)  represents  the  form  of  the  artificial  pupil. 

I  had  intended,  should  the  iris  not  have  been  prolapsed  spontane.  Fig.  3 
pusly,  to  draw  it  out  with  a  small  blunt  hook  which  I  had  prepared 
by  bending  an  Anel's  probe;  (see  fig.  3,)  and  such  an  instrument 
may  be  occasionally  required.  But  I  believe  that  in  the  large  majo- 
rity of  cases  if  the  knife  used  be  a  good  one,  and  the  incision  properly 
made,  the  iris  will  either  be  forced  out  by  the  gush  of  aqueous 
humour,  or  prolapse  soon  afterwards  from  the  pressure  of  the  hu- 
mours. I  am  not  sure  that  a  punctured  wound  with  a  straight  needle, 
especially  if  the  flat  part  were  rotated  in  the  wound  so  as  to  prevent 
immediate  union,  will  not  answer  equally  well,  and  propose  trying  it 
on  a  fitting  occasion. 

This  operation  is  suitable  to  a  number  of   cases,  and  in  such  it  pos- 
sesses advantages  over  those  usually  resorted  to. 


1 


Art.  XIX. — Improvement  on  the    Tourniquet,   by    Silon  A.  Henkel, 
M.D.,  of  New  Market,  Va.     (With  a  wood-cut.) 

Constructed  as  the  tourniquet  commonly  is,  the  band  is  very  apt  to  be  cut 
by  the  tongue  of  the  buckle.  Professor  Gibson  mentions  in  his  lectures, 
that  this  instrument  is  in  this  respect  defective.  To  remedy  this,  he  cautions 
his  pupils  not  to  have  the  tongue  of  the  buckle  too  sharp.  But,  be  the 
tongue  as  it  may,  the  band  is,  from  the  immense  strain,  still  very  apt  to  be 
slit.  To  avoid  this,  I  have  devised  the  following  plan.  I  sew  to  one  end  of 
the  band,  four  feet  long,  a  slide,  marked  S.  in  the  accompanying  drawing. 
The  band  is  then  passed  through  the  rollers  of  the  tourniquet  in  the  usual 
way.  The  end  to  which  the  slide  is  not  attached,  is  then  passed  through 
No.  VIII.— October,  1812.  SZ 


374 


Henkel's  Improvement  on  the  Tourniquet, 


[Oct. 


the  upper  bar  of  the  buckle  B,  and  then  back  through  the  rollers,  so  as  to 
come  under  the  slide;  thus  making  the  band  through  the  rollers  double. 
The  end  to  which  the  slide  is  not  attached,  is  then  passed  around  the  arm  or 


leg,  and  through  the  lower  bar  of  the  buckle, 
and  then  back  through  the  lower  bar  of  the 
slide,  thence  to  the  third  bar  of  the  buckle,  and 
there  fastened;  thus  making  the  band  between 
the  buckle  and  slide  triple. 

The  third  bar  of  the  buckle  is  fastened  to  the 
buckle  with  the  same  wire  that  holds  the  tongue 
in  place.  The  third  bar  reaches  down  as  low 
and  is  as  wide  as  the  lower  bar.  The  points  of 
the  tongue  rest  on  the  third  bar;  which  latter  is 
movable  like  a  hinge  at  the  point  at  which  the 
wire  passes  through. 

In  this  way  a  limb  may  be  compressed  as 
hard  as  usual,  and  the  tongue  of  the  buckle 
subjected  comparatively  to  no  strain  what- 
eveJT, 


Fig.  1. 


1842.]  375 


REVIEWS 


Art.  XX. — I)u  Traitement  Moral  de  la  Folie.    Par  F.  Leuret,  Medecin 

de  I'Hospice  de  Bicetre.     Paris,  1840:  pp.  462. 
On  the  Moral  Treatment  of  Insanity.     By  F.  Leuret,  Physician  to  the 

Bicetre  Asylum.     Paris:  1840. 

In  the  annals  of  every  department  of  science,  there  have  been  those  u'ho 
have  undeservedly  laid  claim  to  valuable  innovations,  or  important  disco- 
veries;— pretenders  who,  either  conscious  of  their  own  demerits,  and 
voluntarily  attempting  to  dupe  and  to  deceive,  or,  with  a  species  of  mono- 
mania, firmly  believing  in  the  truth  of  the  false  doctrines  which  they 
advanced,  have  contended  for  superiority  in  the  particular  branches  to  which 
their  attention  has  been  devoted.  Nor  is  it  less  true,  that  in  the  same 
annals,  we  find  those  who,  by  profound  investigation,  or  a  long  and  patient 
observation  of  facts,  have  changed  the  current  of  research  and  of  thought, 
overthrown  principles  which  had  long  been  received  as  true,  demolished 
the  fair  but  false  fabric  of  established  doctrines,  annihilated  theories  which 
had  previously  received  the  sanction  of  mankind,  and  established  new  sys- 
tems upon  the  basis  of  truth,  where  those  of  former  times  had  been  founded 
but  in  error.  These  the  successful  pioneers  in  the  march  of  truth  have, 
whether  they  advanced  their  claims  or  not,  received  the  guerdon  due  to 
their  merits,  and,  like  Copernicus  and  Newton  in  astronomy.  Bacon  in 
philosophy,  Franklin  in  electricity,  Dalton  in  chemistry,  and  Galvani  in 
the  science  to  which  he  was  devoted,  have  been  recognized  as  leaders  in 
the  crusade  for  wresting  the  temple  of  truth  from  the  pagan  power  of 
error. 

False  pretensions  may  appear  beneath  a  garb  so  fair,  and  error  may  be 
clad  in  a  garment  bearing  so  strong  a  semblance  to  that  of  truth,  that  man- 
kind may  for  a  time  be  led  astray,  and  pretenders  enjoy,  for  a  season,  the 
honours  to  which  they  are  not  entitled.  But  time  and  circumstance,  obser- 
vation and  investigation  at  length  dispel  the  delusion,  and  he  alone  who 
possesses  true  claims  will  retain  the  distinction  which  he  may  have 
acquired. 

The  students  of  mental  alienation,  and  those  who  are  devoted  to  its 
treatment,  have  recently  been  startled  from  their  equanimity,  their  previ- 
ous opinions  being  shaken  for  a  time,  at  least,  by  the  publication,  in  Paris, 
of  a  new  work  upon  the  treatment  of  insanity,  by  F.  Leuret,  Physician 
to  the  Bicetre  Asylum  for  the  Insane. 

"The  object  of  this  work,"  says  the  author,  "is  to  make  known  the  results 
of  my  observations  and  researches  upon  the  treament  of  mental  alienation,  and 
to  establish  the  truth  of  the  following  propositions. 

"  1st.  If  it  be  true  that  insanity  depend  upon  an  alteration  of  the  encephalon, 
we  know  not  in  what  this  alteration  consists. 

"2d.  The  moral  treatment  generally  adopted  is  considered  only  as  an  auxili- 
ary to  the  physical  treatment. 


376  Reviews,  [Oct. 

"3d.  The  intellect  and  passions  of  tlie  insane  cannot  be  restored  to  their 
integrity  without  the  aid  of  moral  treatment;  and  this  is  the  onlt/  method  of  treat- 
ment vjhich  has  a  direct  influence  upon  the  symptoms  of  insanity ,''"' — P.  7. 

To  the  truth  of  the  first  two  propositions  we  were  prepared  to  yield 
unqualified  assent,  without  following  the  author  through  his  process  of 
demonstration.  Upon  reading  the  third,  however,  we  doubted  the  possi- 
bility of  its  demonstration,  unless,  indeed,  it  were  given  to  prove  the  nega- 
tive by  a  reductio  ad  absurdum  of  the  affirmative.  But  the  broad  field 
for  opposition  in  which  the  author  exposes  himself,  in  the  proposition 
itself,  becomes  very  much  restricted  by  the  following  explanation. 

"  Contrary  to  the  generally  received  opinions,  I  consider  moral  treatment  as 
the  only  method  of  curing  insanity;  and,  to  combat  this  disease,  the  physical 
treatment,  that  which  consists  in  the  employment  of  bleeding,  baths  and  phar- 
maceutic preparations,  appears  to  me  as  useless  as  they  could  be  to  one  who, 
in  a  philosophical  and  moral  discussion,  should  make  use  of  them  to  convince 
his  adversaries.  But  here  it  is  necessary  to  make  a  distinction  which  is  of  the 
highest  importance.  Among  the  insane,  some  have  only  a  derangement  of  rea- 
son; others  have  some  physical  lesion  and  present  symptoms  appreciable  to  the 
senses,  as  paralysis,  apathy,  agitation,  loquacity,  fever,  &c.  &c.  Against  these 
symptoms^  the  employment  of  certain  remedies^  ahuays  indicated^  is  sometimes  effec- 
tual^ ajid  ought  not  to  be  neglected.  On  the  contrary,  in  simple  derangement  of 
The  reason,  in  cases  where  insanity  exists  without  complication,  moral  treatment 
alone  is  indicated."^"* — P.  5. 

This  exposition,  however,  contains  a  proposition,  asserted  as  a  fact, 
which  has  not  been,  and,  in  the  present  state  of  our  knowledge,  cannot  be 
demonstrated  to  be  true.  We  allude  to  the  statement  "  some  have  only  a 
derangement  of  reason,"  &c.  Now  it  is  well  known  that  a  majority  of 
the  most  prominent  writers  upon  insanity,  whether  Americans  or  Europe- 
ans, promulgate  the  doctrine  of  invariable  physical  disorder  in  cases  of 
that  disease.  The  author  himself  was  not  ignorant  of  this  fact  when  he 
wrote  the  following  paragraph. 

"The  greater  number  of  authors  unite  in  saying  that,  in  certain  cases  of 
insanity,  there  is  no  lesion  of  the  brain;  on  the  contrary,  some  assure  us  that  such 
a  lesion  always  exists^  but  not  being  able  to  say  what  it  is,  they  suppose  that, 
eventually,  it  will  be  ascertained. "~P.  65. 

Leuret,  it  is  true,  claims  the  majority  for  the  doctrine  of  uncomplicated 
mental  disorder;  we  claim  it  for  the  opposite  direction.  At  present,  how- 
ever, it  is  not  our  intention  to  combat  this  fundamental  principle;  our  prin- 
cipal object  is  to  give,  as  briefly  as  possible,  an  accurate  account  of  the 
manner  in  which  our  author,  believing  in  that  doctrine,  has  acted  upon  it 
in  his  curative  treatment  of  the  insane.  The  only  cases,  as  will  appear 
from  what  precedes,  to  which  an  exclusive  moral  treatment  is  applicable, 
are  those  in  which,  according  to  our  author,  there  exists  no  physical 
lesion.  What,  then,  are  the  moral  means  sufficiently  potent  to  meet  the 
exigencies  of  these?  Aside  from  the  ordinary  resources  of  labour,  amuse- 
ment and  recreation,  he  would  "  combat  ideas  by  ideas,  and  passions  by 
passions."  Grief  and  joy,  hope  and  fear,  the  indidgence  of  vanity,  or  its 
abasement,  in  short,  all  or  any  of  the  passions  and  feelings  are  to  be  called 
into  action,  according  to  the  case,  whenever  there  is  a  reasonable  prospect 
of  benefit  therefrom.  Physical  pain,  either  by  its  actual  infliction,  or  by 
its  influence  in  exciting  fear,  by  continually  being  held  up  as  a  bugbear 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity.  377 

before  the  view  of  the  patient,  is  also  one  of  the  most  important  articles  in 
the  moral  materia  medica. 

"  Pain,  "says  the  author,  "  has  the  same  influence  with  the  insane,  that  it  exer- 
cises in  the  ordinary  course  of  life — or  in  education.  It  is  a  motive  power  which 
banishes  evil,  and  promotes  the  search  for  g'ood;  but  it  is  far  from  being  always 
necessary.  There  are  numerous  analogies  between  children  and  hmatics.  He 
who  in  educating-  the  former,  knows  only  how  to  make  them  suffer,  will  leave 
them  ignorant  and  render  them  stupid;  and  he  who,  in  attempting  to  cure  the 
latter,  should  employ  intimidation  alone,  will  destroy  whatever  traces  of  intel- 
lectual and  moral  faculties  still  remain  to  them." — P.  157. 

"To  excite  pain,  1  generally  employ  the  douche  and  cold  affusions.  The 
patient  being  made  to  lie  upon  the  floor,  I  have  several  buckets  of  cold  water 
thrown  upon  his  body.  To  take  the  douche,  he  sits  in  a  bathing-tub  filled  with 
tepid-water,  a  stop-cock,  the  calibre  of  which  is  about  one  inch,  is  opened,  and 
the  water  falls  from  the  height  of  six  feet  upon  his  head.  This  is  continued 
from  two  or  three,  to  twenty  or  thirty  seconds.  If  my  object  be  then  obtained, 
I  allow  the  patient  to  withdraw,  if  not,  the  douche  is  repeated  several  times  in 
succession." — P.  158. 

"  When  I  have  obtained  one  concession,  I  am  not  satisfied;  I  require  others  on 
the  succeeding  days;  the  more  I  obtained,  the  more  I  required;  and,  if  a  cure  be 
probable,  I  do  not  stop  until  it  is  attained." — P.  163. 

That  the  douche  and  the  cold  affusions  are  not  so  severe  as  might  be 
apprehended.  Dr.  L.  assures  us,  both  from  his  own  experience  and  that  of 
his  students.  They  subjected  themselves  to  both,  for  as  long  a  period  as 
it  was  customary  to  subject  the  patients.  In  regard  to  the  use  of  them, 
the  author  makes  the  following  judicious  remarks. 

"  It  is  not  necessary  always  to  resort  to  the  employment  of  the  douche  and 
affusions;  they  should  be  used  for  those  cases  alone  in  which  there  is  no  proba- 
bility of  success  from  milder  means." — P.  165. 

In  regard  to  amusements  and  manual  labour  for  the  insane,  Leuret  ap- 
pears to  be  as  fully  impressed  of  their  utility  as  any  author  who  has  writ- 
ten upon  the  subject.  He  speaks  of  the  former,  however,  as  being  of 
*'  very  secondary"  importance,  and,  as  a  curative  agent,  greatly  prefers  the 
latter.  After  giving  the  history  of  its  introduction,  by  Dr.  Ferrus,  among 
the  patients  of  the  Bicetre,  he  says  that  it  is  still  continued,  to  so  great  an 
extent  that  "  the  director  rarely  leaves  the  convalescent  patients  without 
work."—?.  169. 

In  reference  to  the  objections  which  have  been  raised  against  the  intro- 
duction of  manual  labour  into  hospitals  devoted  to  the  wealthier  classes  of 
society,  and  to  the  difficulty  of  inducing  such  patients  to  resort  to  such 
employment,  he  says: 

*'  These  objections  appear  to  be  more  specious  than  real.  The  wishes  of 
lunatics  ought  not  to  be  the  rule  of  the  physician  charged  with  their  treatment. 
Their  repugnances  should  be  respected  but  not  yielded  to.  Prepare  your  shops, 
organize  your  labour,  and  with  a  little  address  and  perseverance,  it  will  not  be 
difficult  to  engage  all,  or  nearly  all,  of  your  convalescent  patients.  Some  slight 
privations  for  those  who  will  not  work,  and  favours  to  those  who  punctually 
resort  to  this  employment,  will  very  soon  people  your  shops." — P.  182. 

Great  importance  is  attached  to  intellectual  exertion,  particularly  the 
exercise  of  the  faculty  of  memory.  To  facilitate  the  employment  of  these 
means,  a  school  has  been  established  in  the  Bicetre,  which  is  attended  by 
two  or  three  hundred  of  the  patients. 

"  I  take  advantage,"  says  the  author,  "  of  the  resources  thus  presented  for  ex- 

32* 


378  Reviews,  [Oct. 

ercising  the  intellect  of  my  patients,  whether  learned  or  ignorant;  and  I  diver- 
sify, as  much  as  possible;  their  studies." — P.  172, 

As  the  patients  at  the  Bicetre  are  principally  paupers,  the  higher 
branches  of  education  cannot  be  introduced  to  much  extent.  Orthography, 
reading,  writing,  arithmetic,  and  the  recitation  of  dialogues  are  the  princi- 
pal exercises. 

In  regard  to  music,  our  author  thus  exhibits  his  views. 

"  I  have  made  use  of  music  and  singing.  There  are  few  physicians  to  the 
insane,  who  have  not  resorted  to  this  method  of  entertainment.  Their  attempts, 
however,  appear  to  have  been  insufficient  to  justify,  thereby,  a  solution  of  the 
question  of  its  efficacy  in  the  treatment  of  insanity;  and  I  reproach  those  who 
have  made  the  attempts,  for  having  too  hastily  abandoned  it." — P.  176. 

He  then  relates  an  interesting  case  in  which  music  was  the  primary 
agent  in  effecting  a  rapid  restoration,  and,  after  describing  the  daily  musi- 
cal exercise  of  the  patients  under  his  care,  says:  I  have  the  satisfaction, 
when  quitting  my  patients,  of  leaving  them  in  the  enjoyment  of  pleasant 
ideas  and  sensations,  which,  increasing  from  day  to  day  with  those  who 
are  curable,  cannot  fail  to  facilitate  their  restoration." — P.  177. 

Mr.  Wilkem,  a  professor  of  music,  having  witnessed  the  exercises  at 
Bicetre,  "  has  conceived,"  says  the  author,  *'  a  project  of  musical  educa- 
tion adapted  to  the  intellectual  condition  of  our  patients;  a  project  which 
I  hope  soon  to  be  able  to  put  in  operation." — P.  178. 

Another  method  of  discipline  is  thus  spoken  of. 

"  Whenever  the  weather  will  permit,  all  the  patients  who  are  in  a  condition 
to  walk,  and  who  cannot  or  will  not  work,  are  collected  in  the  court  of  the  asy- 
lum and  exercised,  like  soldiers,  in  marching.  Imitation  is  so  potent,  even 
among  the  most  indolent  and  obstinate,  that  1  have  seen  many  patients  of  this 
character  who,  refusing  at  first,  have  at  length  consented  to  march.  This  is  a 
commencement  of  regular,  rational  and  methodical  action,  which  will  lead  to 
something  of  more  importance." — P.  178. 

"  I  always  employ  the  patients  as  commanders  of  the  evolutions,  selecting 
those  who  manifest  greater  intelligence  and  goodwill  than  the  others.  These 
are  made  the  recipients  of  some  special  favours,  in  order  to  direct  attention  to 
them  and  encourage  other  patients  who  would  imitate  them." — P.  179. 

A  case  is  related,  in  which  this  exercise  a  la  militaire,  so  far  improved 
the  patient  that,  from  being  completely  inactive,  lethargic  and  stupid,  he 
became  an  industrious  labourer. 

Subsequent  to  his  general  and  specific  remarks  upon  treatment.  Dr.  L. 
reports  numerous  cases  of  the  "  application  of  moral  treatment  to  lunatics 
who  presented  no  alteration  of  physical  health."  These  are  arranged  ac- 
cording to  the  type  of  the  disease,  as  follows. 

"  1st.  Those  labouring  under  hallucinations. 

*'2d.  Those  who  reason  falsely  on  account  of  previous  hallucinations. 

"3d.  Lypemaniacs,  with  or  without  hallucinations. 

"4th.  People  from  humble  life  wishing  to  marry  princesses. 

"5th.  Those  who  would  civilize  the  world. 

"6th.  The  possessors  of  imaginary  titles  and  dignities." — P.  186. 

No  one,  whether  he  be  a  convert  or  not  to  the  doctrine  of  Leuret,  can 
read  these  cases  without  the  deepest  interest.  If  they  be  faithfully  report- 
ed, and  we  have  not  the  slightest  reason  for  doubting  their  accuracy,  the 
Dr.  has  certainly  effected  much,  and,  therefore,  does  not  urge  his  opinions 
upon  the  members  of  the  profession  without  some  claim  to  their  respectful 
consideration.     Inasmuch  as  the  work  before  us  has  not  been  translated 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity.  379 

into  English,  and  the  French  edition  is  but  little  known  in  this  country, 
and,  furthermore,  in  order  to  give  the  author  a  fair  hearing  before  the  tri- 
bunal of  the  profession,  we  shall  present  the  translation  of  a  case  from  each 
of  the  classes  aforementioned. 

Class  Is^.— Case.  "  Urban  M.*  setat.  30  years,  entered  Bicetre  May  29th,  1838. 
At  the  morning  visit  I  found  him  feeble,  emaciated,  and  lying  upon  his  back  in 
bed.  He  had  refused  to  eat,  drink,  speak  or  move.  By  the  curiosity  and  inqui- 
etude of  his  look,  I  presumed  that  he  was  partially  aware  of  what  was  passing 
around  him,  and,  consequently,  that  he  was  not  deprived  of  all  intelligence. 
The  absence  of  fever,  and  the  apparent  integrity  of  the  thoracic  and  abdominal 
viscera,  induced  me  to  believe  that  the  first  thing  to  be  done  was  to  furnish  him 
with  aliment.  I  subsequently  ascertained  that  lie  had  eaten  nothing  during  the 
last  eight  or  ten  days.  As  he  had  previously  refused  to  speak  when  interro- 
gated, I  asked  him  no  questions,  in  order  to  avoid  giving  him  an  opportunity  of 
refusing  to  do  whatever  I  might  require  of  him.  But,  without  appearing  to  care 
whether  he  spoke  or  not,  I  said,  *Itis  necessary  that  this  man  should  drink 
something.  Let  us  make  him  drink.'  I  held  his  nose,  and  poured  some  soup 
into  his  mouth.  At  first,  he  made  no  eflfort  either  to  swallow  or  to  breathe,  and 
during  the  inconvenience  which  he  felt  from  the  absence  of  respiration,  I  asked 
if  ice  had  been  put  into  the  reservoir,  adding,  that  if  Urban  should  eject  the  soup 
instead  of  swallowing  it,  he  should  immediately  be  placed  under  the  douche. 
From  fear  of  the  latter,  or  from  the  necessity  of  breathing,  he  swallowed  the 
soup.  He  then  made  motions  with  his  hands,  perhaps  in  token  of  gratitude,  but 
1  pretended  not  to  see  them,  and  left  him  quiet  for  several  hours.  In  the  after- 
noon, having  made  him  swallow  some  more  soup  in  the  same  manner  as  before, 
I  ordered  him  to  be  dressed.  He  was  taken  from  bed  and  his  clothes  put  on 
without  his  making  a  single  motion,  but,  this  being  done,  he  consented  to  stand 
up.  Two  attendants,  supporting  him  by  the  arms,  led  him  to  a  garden  where 
other  patients  were  at  work.  They  were  ranged  in  a  line  for  the  purpose  of 
removing  some  stones  from  one  place  to  another.  We  placed  Urban,  feeble  as 
he  was,  among  them,  and  when  his  neighbour  presented  him  a  stone,  he  looked 
at  it,  smiled,  and  after  a  moment's  hesitation,  took  it  and  passed  it  to  the  next. 
He  worked  slowly  at  first,  but  soon  became  more  active,  and  at  length  laboured 
nearly  as  well  as  his  companions.  While  they  were  employed,  a  large  dish  of 
soup  was  brought  at  my  order,  with  a  spoon  for  each  patient.  The  chain  was 
broken,  the  labourers  came  to  eat,  and  one  of  them  invited  Urban  to  partake 
with  them.  He  permitted  himself  to  be  led  to  the  dish,  took  a  spoon,  and  ate 
nearly  as  well  as  the  others.  I  manifested  neither  satisfaction  nor  astonishment, 
and  did  not  appear  to  have  my  attention  directed  towards  him.  Wine  being 
subsequently  brought,  I  ordered  that  but  one  tumbler  should  be  used  for  all,  in 
order  to  banish  from  the  mind  of  Urban  any  fear  of  poison  which  he  might  have 
imbibed,  but  of  the  existence  of  which  I  was  not  assured.  They  drank  in  turn, 
commencing  with  the  oldest.  Coming  to  Urban,  he  hesitated;  but,  as  another  was 
waiting  for  liim,  he  at  length  drank.  In  the  evening  he  ate  nothing,  and  instead 
of  drinking  what  was  offered  him,  he  took  the  spitoon  and  swallowed  its  contents. 

"The  next  day  Urban  appeared  less  feeble  and  more  animated  than  before, 
and  allowed  his  tongue  to  be  seen.  It  was  in  a  healthy  state,  and  his  pulse 
beat  54  to  the  minute.  Another  physician  making  the  visit,  prescribed  3  cut 
cups  to  the  nucha,  a  hath  with  warm  affusions  to  the  head,  vinous  lemonade, 
a  laxative  enema,  pediluvium,  milk  and  soup.  In  the  course  of  the  morn- 
ing, the  cups  were  applied;  but  he  could  not  be  made  to  drink  or  to  eat. 
We  then  made  him  get  up,  and,  after  being  dressed,  obliged  him  to  bring 
several  buckets  of  water  for  the  use  of  the  ward.  Some  bread  and  boiled 
eggs  were  put  in  his  pocket,  which,  when  left  alone,  he  ate.  He  also 
drank  some  milk.  The  third  day,  on  taking  him  out  of  doors  to  work,  being 
overtaken  by  a  shower,  we  found  shelter  beneath  the  portico  of  a  wine-shop. 

*  The  names  of  patients  used  in  these  cases  arc  all  fictitious. 


380  Reviews,  [Oct. 

M.  Picard,  an  interne  of  the  Asylum,  and  myself  took  the  occasion  to  proffer 
him  our  friendship,  to  testify  the  interest  we  felt  in  his  case,  and  our  ardent 
desire  to  raise  him  from  his  unhappy  condition.  He  manifested  no  gratitude 
other  than  what  might  be  inferred  from  a  pressure  of  the  hand  of  M.  Picard. 
Having  ordered  wine,  sugar  and  bread,  he  drank  a  large  glass  of  the  first,  put 
the  sugar  in  his  pocket  and  afterwards  ate  it,  but  refused  the  bread.  The  wea- 
ther becoming  fair,  he  went  to  work,  and  subsequently  ate  more  food.  The 
fourth  day  he  refused  both  to  speak  and  to  eat,  and  some  soup  being  put  in  his 
mouth,  he  threw  it  out.  As  the  use  of  the  stomach-tube  is  not  without  incon- 
venience, we  resorted  to  the  douche.  The  patient  bore  this  very  well  for  a 
while;  but  it  soon  troubled  him,  and,  for  the  first  time  that  day  he  spoke,  ex- 
claiming mein  Gott!  viein  Gott!  I  pretended  not  to  understand  him,  and  required 
him  to  eat  and  drink.  He  complied,  taking  himself  his  food  and  beverage. 
For  nine  days  it  was  necessary  to  resort  to  coercion  in  giving  him  his  food. 
The  stomach-tube  was  used,  and  during  the  last  three  days,  was  submitted  to 
without  opposition.  On  the  ninth  day  he  consented  to  speak  and  to  eat.  I 
never  knew  the  motive  which  induced  him  to  refuse  nutriment.  When  ques- 
tioned upon  the  subject,  perhaps  he  thought  the  motive  so  absurd  that  he  was 
•unwilling  to  reveal  it.  He  did  not  speak,  because,  as  he  believed,  we  could  all 
read  his  thoughts  as  they  arose  in  his  mind.  Those  around  him,  physicians, 
patients  and  attendants,  were  a  superior  order  of  beings  who  heard  his  thoughts, 
though  they  were  not  uttered.  He,  on  the  contrary,  was  a  mere  mortal,  unable 
to  know  our  thoughts;  and  this  sense  of  inferiority  rendered  him  very  unhappy. 
"Thoughts,  in  his  mind,  were  accompanied  by  the  sound  of  words,  and  his 
thoughts  were  all  his  own,  different  from  most  patients  labouring  under  halluci- 
nations, since  they  generally  attribute  their  speaking  thoughts  to  an  interlocutor, 
and  answer  them  by  words.  Having  obtained  the  confidence  of  Urban,  we  kept 
him  as  constantly  occupied  as  possible,  in  order  to  withdraw  his  attention  from 
his  speaking  thoughts.  He  now  began  to  judge  accurately  upon  that  which 
passed  around  him,  understood  that  he  was  in  an  asylum,  and  that  his  compa- 
nions were  lunatics,  ceased  to  believe  that  we  were  beings  of  a  superior  nature, 
or  that  we  could  read  his  thoughts,  and  finally  left  the  asylum  cured  on  the  26th 
of  July,  having  been  under  treatment  about  two  months." 

Class  2c?.— Case.  "February  13th,  1838,  Vincent,  a  young  man,  sstat.  26 
years,  entered  the  Bicetre,  and  on  the  following  morning  1  found  him  standing 
at  the  foot  of  his  bed,  apparently  absorbed  in  thought,  but  disposed  to  answer 
my  questions.  He  assured  me  that  he  was  well,  and  could  not  conceive  why  he 
had  been  sent  to  the  asylum.  Being  asked  if  he  thought  he  had  enemies,  he 
said  he  believed  he  had  some  who  were  very  dangerous.  Persons  living  in  the 
house  with  him  had  placed  boxes  on  the  stairs,  for  the  purpose  of  making  him 
fall.  They  had  also  put  into  the  vault-pipe  of  the  necessary,  an  'infernal  ma- 
chine,' which  would  explode  when  he  presented  himself,  and  had  intercepted 
some  merchandize  destined  for  him,  through  jealousy  lest  his  trade  should  be- 
come lucrative.  He  had  been  to  the  commissary  of  police,  to  make  known  his 
grievances,  but  that  functionary  instead  of  rendering  him  justice,  had  sent  him 
to  a  hospital  for  the  insane.  He  related  other  absurdities,  to  which  I  listened 
with  seriousness,  but  without  an  aspect  of  severity.  When  he  had  finished,  I 
turned  to  the  attendants  accompanying  me,  and  said, '  Here,  gentlemen,  you  see 
one  of  those  evil-doers  {mauvais  sujets)  who,  from  time  to  time,  are  sent  to  us 
by  the  police, — a  vagabond,  who  thinks  he  can  obtain  subsistence  here  without 
labour;  or,  perhaps  still  worse,  he  may  have  committed  some  evil  act,  and  now 
endeavours  to  evade  the  law  by  feigning  insanity.  We  will  not  be  deceived  by 
his  stratagem.  You,  as  well  as  I,  do  not  believe  a  word  of  what  he  has  told  us. 
An  infernal  machine  against  such  a  man  as  he!  boxes  placed  upon  the  stairs  to 
make  him  fall!  Men  v^ho  follow  him  when  in  the  country!  has  all  this  even  the 
shadovi^  of  probability'?'  I  continued  in  this  manner,  showing  the  students  that 
all  the  ideas  of  the  patient  were  without  foundation;  and  that  to  talk  to  us  as  he 
had  done,  was  to  take  us  all  for  lunatics.  The  students  assented,  and  said  even 
more.     None  of  us  spoke  to  the  patient,  and  we  left  him  somewhat  confounded 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity,  381 

by  our  singular  reception  of  him.     I  ordered,  in  his  presence,  that  he  should 
work  all  day,  and  be  well  watched,  that  I  might  be  informed  of  whatever  he 
might  say  in  regard  to  the  falsehoods  which  he  had  just  uttered.     He  worked  in 
silence.     The  next  day,  assuming  a  sarcastic  tone,  I  urged  him  to  write  for  his 
relations  to  come  and  take  him  away,  as  1  did  not  want  him  in  an  asylum  where 
we  received  only  honest  men.     He  said  he  would  like  to  leave,  but,  without 
assigning  a  sufficient  reason,  refused  to  write  to  his  friends.  I  had  him  taken  to 
the  douche  and  told  him  I  should  subject  him  to  it  for  three  hours.     After  the 
water  had  fallen  a  iew  seconds,  he  appeared  much  annoyed  by  it.     I  ordered  it 
to  be  stopped,  and  asked  him  if  he  would  obey.     He  answered  in  the  affirma- 
tive: but  this  did  not  satisfy  me;  I  required  a  full  explanation  of  all  the  foolish 
stories  he  had  told  me  on  the  preceding  day,  giving  him  the  precautionary  warn- 
ing, that  if  the  answers  were  not  reasonable,  1  should  continue  the  douche  as  I 
had  promised;  and  that  it  should  be  repeated  every  day  until  he  should  stop  en- 
deavouring to  dupe  me.     His  answers  were  perfectly  rational,  and  when  I 
feigned  to  doubt  his  sincerity,  he  repeated  a  part  of  what  I  had  said   to  the 
students,  on  the  preceding  day,  in  regard  to  the  absurdity  of  his  fears.     I  now 
expressed  my  satisfaction  for  so  happy  a  change;  freely  forgave  his  wrongs  to- 
wards me,  attributing  them  to  his  disease  rather  than  to  an  intention  to  deceive. 
I  released  him  from  the  three  hours'  douche;  he  thanked  me  kindly,  and  we 
parted  very  good  friends.     On  the  succeeding  days  he  continued  to  work,  and 
when  his  hallucinations  were  mentioned,  hastened  to  assert  that  he  no  longer 
believed  them.  On  the  24th  of  February,  eleven  days  after  his  admission,  I  had 
him  taken  to  my  office,  where  I  received  him  with  cordiality,  and  interrogated 
him  in  regard  to  the  cause  of  his  disease.     He  informed  me  that  there  was  no 
insane  person  in  his  family,  that  he  had  been  very  sedentary  for  several  months, 
had  lived  very  abstemiously,  working  eighteen  hours  per  diem,  and  taking  no 
recreation.     Concerning  the  infernal  machine,  he  said  that  the  winter  being 
severe,  the  porter  had  told  him  not  to  throw  anything  into  the  vault-tube,  as  it 
would  freeze.     His  imagination  supplied  the  rest,  as  it  did  in  regard  to  the 
boxes  upon  the  stairs.     Notwithstanding  his  assurances  that  he  was  completely 
cured  of  his  '  foolish  ideas,'  as  he  called  them  himself,  I  perceived  that  he  con- 
tinued to  speak  of  them,  his  countenance  became  more  animated  and  he  appear- 
ed to  consider  them  realities.     I  stopped  the  conversation,  reminded  him  of  the 
promises  made  under  the  douche,  and  encouraged  his  good  resolutions.     Subse- 
quently, I  never  saw  him  without  having  a  little  merriment  at  his  expense; — the 
students  did  the  same,  until  the  recollection  of  his  hallucinations  became  dis- 
agreeable and  almost  painful  to  him.     Finding  that  his  reason  had  resumed  its 
integrity,  we  discontinued  our  sarcasm.  On  the  8th  of  March,  less  than  one  month 
from  the  time  of  his  admission,  he  was  discharged,  restored,  by  Dr.  Ferrus." 

Class  3d. — Case.  "  Madame  Eugene  X.,  entered  the  hospital  of  M.  Esquirol 
in  May,  1833.  Several  years  anterior  to  that  time,  she  had  a  nervous  disease 
during  which  she  believed  her  soul  to  be  lost.  Subsequently  to  that  attack,  she 
left  the  gay  society  of  the  city,  and  retiring  to  the  country,  led  a  very  secluded 
and  abstemious  life.  When  the  cholera  approached,  she  suffered  much  from 
fear,  and  to  avoid  taking  it,  resumed  a  stimulating  diet,  drinking  wine  and  aro- 
matic infusions.  She  was  soon  attacked  with  palpitation  of  the  heart,  and  a 
*  particular  excitement'  during  which  her  conscience  was  much  troubled.  Eight 
leeches  being  applied  to  the  precordia,  the  blood  which  he  drew  produced  great 
prostration,  followed  by  the  loss  of  sensibility,  with  inquietude  and  insomnia. 
Her  religious  fears  now  returned;  she  believed  her  soul  doomed  to  perdition, 
went  to  confession,  and  although  absolution  was  given,  she  said  that  she  had  not 
received  it,  and  did  not  feel  that  tranquillity  which  pardon  for  sin  ought  to  pro- 
duce. Sombre  and  silent,  she  passed  the  time  unoccupied,  in  one  corner  of  her 
apartment,  or  roamed  without  object  across  the  fields,  uttering  cries  which  might 
be  heard  at  a  great  distance.  Being  brought  to  Paris,  she  was  placed  in  a  con- 
vent where  spiritual  consolation,  prayers,  religious  songs,  rosaries  and  absolu- 
tions were  employed  without  any  favourable  effect.     She  was  then  placed  in  the 


382  Reviews.  [Oct. 

hospital.  When  I  first  saw  her,  she  related  the  history  of  her  disease,  adding^ 
'  I  know  I  shall  never  recover;  it  is  impossible  to  cure  hell,  although  they  have 
attempted  it!  Put  me  in  some  remote  place  where  no  one  can  hear  from  me,  for 
I  do  not  want  others  to  suffer  from  my  wretchedness.'  Her  physical  health 
appeared  to  be  good:  appetite  normal;  stools  natural;  menstruation  regular;  age, 
42  years;  duration  of  disease,  six  months.  I  assured  her  that  she  would  reco- 
ver, and,  in  opposition  to  her  request  for  isolation,  placed  her  in  an  apartment 
with  a  dozen  other  patients.  She  appeared  frightened,  and  wanted  to  go  home. 
I  promised  to  place  her  in  another  apartment,  if  it  were  necessary;  but  time 
alone  could  demonstrate  that  necessity.  She  became  a  little  more  calm.  She 
generally  screamed  in  the  night.  As  soon,  therefore,  as  the  nervous  agitation 
producing  this  effect  came  on,  I  had  her  conducted  to  the  bath.  I  then  said  to 
her,  '  I  depend  very  much  upon  long-continued  cold  baths  for  calming  your  ner- 
vous agitation.'  She  had  no  confidence  in  this  or  any  other  means.  About 
midnight,  not  having  been  asleep,  she  began  to  scream.  Her  attendant  inform- 
ed her  that  a  bath  was  prepared.  '  A  bath  at  midnight!'  she  exclaimed,  ''tis 
impossible!'  'We  give  baths  at  all  hours,'  was  the  answer,  'and  we  will 
certainly  calm  you.'  Several  cases  of  cures  by  them  were  then  related  for  her 
encouragement.  At  length  she  consented,  took  the  bath,  and  stopped  screaming. 
She  grumbled  a  little,  but  no  notice  was  taken  of  it.  She  was  congratulated  on 
the  happy  effects  of  the  bath,  and  advised  to  resort  to  it  immediately  upon  the 
return  of  the  nervous  agitation.  She  slept  a  little  after  returning  from  the  bath. 
The  next  night  the  agitation  returned,  but  two  hours  later  than  before.  She  was 
placed  in  the  bath,  with  the  same  result.  On  the  following  afternoon,  violent 
screams.  '  Again  to  the  bath.'  '  But,  sir,  I  was  four  hours  in  the  bath  last 
night.'  'Very  well;  four  hours  more;  the  violence  of  the  disease  determines 
the  duration  of  the  bath  which  will  overcome  it.'  She  now  perceived  that  she 
could  escape  the  bath  only  by  ceasing  to  scream.  She  made  strong  efforts  to 
that  end,  and  was  quiet  several  days. 

"Already  she  was  more  calm  and  less  unhappy;  but  the  disease  continued. 
*  Every  morning,'  said  she,  '  I  wake  feeling  as  well  as  ever.     In  four  or  five 
minutes  I  begin  to  feel  a  kind  of  numbness,  a  pressure  on  the  arms  and  legs, 
and  a  vacuity  of  my  moral  heart.     There,  (touching  the  epigastric  region,)  there 
is  a  vacuity,  and  in  the  side  a  fulness.    The  pressure  on  my  limbs  is  as  if  I  car- 
ried a  house.     It  is  caused  by  the  arrival  of  eight  devils,  to  whose  power  I  am 
consigned.     I  have  no  longer  a  moral  heart.     I  love  nothing;  the  damned  cannot 
love.     The  chain  which  bound  my  heart  to  Heaven  is  broken;  there  can  be  no 
more  communion  between  me  and  God.'    '  Have  you  ever  seen  or  heard  anything 
difierent  from  your  ordinary  sensations]'     '  Once  I  heard  a  voice,  saying  '  thou 
art  lost!'     'When?'     'At  the  commencement  of  my  disease.'     '  Whence  came 
the  voice?'     '  From  the  interior  of  my  body.'     '  How  could  you  decide  that  it 
was  a  voice  and  not  a  thought?''     '  By  the  sound.'     '  Was  it  a  sound  produced  at 
the  same  time  as  the  thought,  or  a  sound  like  the  voice]'     '  Like  the  voice!     I 
wondered  my  attendant  did  not  hear  it.     Do  you  see  the  devils  that  you  feell' 
'No.'    Left  to  herself  Madam  E.  was  silent,  walked  in  the  most  solitary  places, 
often  wept,  thought  it  sacrilege  to  attempt  to  amuse  herself,  and  that  her  only 
occupation  should  be  to  think  of  hell.     Persuasion  and  argument  were  without 
effect  upon  her.     Hoping  to  induce  her  to  work,  I  appealed  to  her  heart.     I 
remarked  in  her  presence  that  a  poor  man,  dangerously  wounded,  had  just  come 
to  me  for  assistance,  and  I  must  have  some  charpie  immediately  to  dress  his 
wounds.     All  the  persons  present  instantly  went  to  work  to  make  it.     A  piece 
of  linen  was  offered  to  E.;  she  took  it  and  began  to  work.     At  first  her  hands 
barely  moved,  but  seeing  others  hurrying,  she  worked  more  rapidly.     The  ice 
was  broken;  we  saw  that  she  could  work,  and  she  was  herself  convinced  of  it. 
One  day  when  she  was  sitting  silent  and  sad,  I  began  to  scold  the  attendant,  in 
her  presence,  for  not  giving  her  a  cold  bath,  adding  that  Madam  E.  ought  to 
work,  and  that  it  was  as  easy  to  sew  or  embroider  as  to  make  charpie.     This 
was  instantly  effectual.     The  patient  told  her  attendant  that  if  I  would  excuse 
her  from  the  bath  she  would  work.  I  consented  to  the  proposition,  and  she  kept 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity.  383 

her  word.  From  that  moment  she  improved  rapidly.  The  fear  of  the  bath  in- 
duced industry,  and  industry  furnished  mental  occupation.  In  about  two  months 
she  was  discharged  well,  and  has  retained  perfect  health  during  the  intervening 
seven  years." 

Class  4t?i. — Case.  "Theodore  T.,  aetat.  43,  entered  Bicetre  September  15, 
1831.  He  then  uttered  cries  nearly  all  day,  pretended  that  Louis  Pliilippe  was 
his  uncle,  and  the  Duchess  of  Berri  his  wife.  He  also  had  the  habit  of  extend- 
ing his  left  arm,  and  exclaiming  'the  left  hand;  the  left  side;  the  other  side  of 
the  water.'  These  actions  were  connected  with  his  political  ideas.  Being  sub- 
jected to  treatment  more  than  a  year  without  success,  he  was  placed  among  the 
incurables  in  October  1832.  Thenceforward  he  laboured  out  of  doors,  but  his 
hallucinations  continued,  and  he  was  constantly  screaming,  'in  order  to  make 
his  defence  heard,'  excepting  in  the  night,  or  when  he  was  in  the  ward.  He 
then  desisted  through  compassion  for  those  around  him.  About  the  beginning 
of  February  1838,  knowing  nothing  of  him  but  his  screams,  I  undertook,  if  not 
to  treat,  at  least  to  study  his  case.  For  fifteen  days  I  made  advances  to  him 
which  he  received  politely;  answered  my  questions,  gave  his  hand  willingly, 
but  always  the  left  one.  His  attention,  however,  could  not  be  fixed  but  for  a 
few  moments  in  succession.  In  the  hope  of  benefiting  him,  I  wrote  a  note 
inviting  him  to  dine  with  me  and  M.  Picard,  an  interne  of  the  Asylum.  He 
declined  the  invitation  in  a  note,  expressing  his  thanks  and  regrets,  and  closing 
thus:  '  Long  live  Henry  the  Fifth!  long  live  her  Royal  Highness,  the  Duch- 
ess of  Berri,  my  wife!  long  live  Louis  Philippe!  Bread  and  water;  No.  7;  til 
Anglaise;  music:  this  left  hand  which  presses  the  pocket-handkerchief,  the  keys, 
departure,  the  doors,  this  letter,  afterwards  long  live  the  left  side!  good-bye  till 
to-morrow.     A  thousand  aflfectionate  remembrances.     Theodore.' 

"Thus  disappointed  in  my  mild  and  persuasive  efforts,  I  changed  my  course. 
Having  ordered  several  of  the  most  turbulent  patients,  and  Theodore  among 
them,  to  be  shut  in  a  room  together,  I  entered,  while  they  were  screaming  loud 
enough  to  split  the  head,  and  told  one  of  them  to  be  silent.  He  refused,  and 
was  sent  to  the  douche.  The  same  was  done  with  the  others,  reserving  Theo- 
dore till  the  last.  Coming  to  him,  I  expressed  astonishment  at  finding  him  in 
such  company;  told  him  I  had  ordered  the  noisy  patients  to  be  shut  up,  in  order 
to  punish  them  if  they  did  not  reform,  but  little  thought  that  I  should  have  to 
punish  him,  for  whom  1  cherished  friendly  feelings.  He  listened  awhile,  but 
soon  interrupted  me  with  screams,  and  I  sent  him  to  the  bath-room.  Again  I 
endeavoured  to  reason  with  him,  but  he  continued  noisy,  and  I  ordered  the 
douche.  He  bore  it  more  than  half  a  minute,  and  then  begged  that  it  should  be 
stopped.  I  consented,  he  giving  his  pledge  of  honour  that  he  would  make  no 
more  noise.  He  was  silent  nearly  all  day.  The  succeeding  day,  on  going  to 
the  field  where  he  was  at  work,  I  heard,  when  far  oflT,  his  hoarse,  loud  voice. 
Approaching,  as  if  irritated,  I  reproached  him  for  forfeiting  his  word.  'I  have 
not  broken  my  word,'  said  he.  '  But  those  cries  that  I  heard  so  far — '  '  They 
were  not  cries;  I  was  talking.  You  forbade  me  to  scream,  but  not  to  speak.' 
'Those  are  Jesuitical  distinctions;  you  must  be  absolutely  silent.'  '  Will  you 
take  the  responsibility  of  my  silence]'  »  Yes.'  '  Beware!  it  is  immense.'  '  I 
take  it,  however,  great  as  it  may  be.'  He  was  silent,  and  I  left  him.  After  he 
returned  from  work,  I  went  to  the  ward  to  see  if  he  kept  his  promise,  and  found 
him  talking  in  the  court,  with  a  package  of  papers  under  his  arm.  1  ordered  him 
to  be  taken  to  the  bath.  After  he  was  placed  in  the  tub,  1  had  several  buckets 
of  cold  water  placed  near,  and  an  attendant  stood  behind  the  patient  with  a  pot 
of  cold  water  ready  to  pour  it  on  his  head.  Theodore,  frightened,  sighed, 
and  was  silent.  1  sat  down  and  placed  the  packet  of  papers  before  him. 
'  What  is  in  this  packet?' I  inquired.  'Some  manuscripts,' said  he.  'Some 
foolish  things,  no  doubt,'  I  continued,  'let  us  see.'  On  opening  them  I  found 
that  they  were  projects  of  government,  dedicated  to  Louis  Philippe,  the  Dukes 
of  Chartres  and  Bordeaux,  and  the  Duchess  of  Berri;  instructions  for  the  royal 
infant,  and  nominations  of  marshals  and  peers  of  France.  '  I  am  going,'  said  I, 
*  to  relieve  you  of  all  this  burthen  of  foolishness  which  only  injures  your  mind.' 


384  Reviews,  [Oct. 

He  entreated  that  I  would  spare  some  of  them.  '  Is  the  water  you  have  very 
cold?'  I  inquired  of  the  attendant.  '  Yes,  I  put  fifty  pounds  of  ice  into  the  reser- 
voir.' Theodore  said  no  more.  Fire  was  brought,  and  I  burned  the  papers 
sheet  by  sheet,  giving-  my  reasons  as  I  proceeded.  From  time  to  time  a  deep 
sigh  betokened  his  regrets,  but  he  said  not  a  word.  It  was  probably  the  first 
time,  for  seven  years,  that  he  had  remained  silent  under  such  annoying  circum- 
stances. The  papers  being  consumed,  I  renewed  my  advice  to  him,  and  he  pro- 
mised to  follow  it.  Meanwhile,  a  cold  rain  had  commenced,  and  was  falling  in 
torrents.  To  return  to  his  room,  he  must  cross  two  courts,  and  would  be  wet  to 
the  skin.  I  seized  the  opportunity  for  showing  him  a  kindness.  Taking  him 
by  the  arm,  and  protecting  him  with  my  umbrella,  I  went  to  his  room,  had  a 
large  fire  kindled,  and  ordered  a  supper  which  I  thought  would  please  him.  He 
answered  my  questions  politely.  Before  leaving,  I  asked  him  for  his  right 
hand;  he  gave  it  with  but  little  hesitation,  and  we  mutually  bade  good-bye. 
From  that  moment  I  felt  certain  of  curing  him.  Subsequently,  I  required  him 
to  commit  to  memory  some  of  Boileau's  verses.  He  learned  them  during  the 
intervals  of  labour,  and  recited  them  to  me  at  evening.  At  these  times  I  con- 
versed with  him  on  general  subjects,  and  the  students  did  the  same,  until  he 
was  well  enough  to  be  made  overseer  to  some  of  the  other  patients.  He  now 
gave  me  a  history  of  his  disease. 

"  In  1828  he  began  to  entirely  neglect  his  own  affairs,  devoted  himself  to  poli- 
tics, drew  up  a  project  for  saving  Charles  Tenth  from  dethronement,  and  had  it 
presented  to  the  king.  From  neglect  he  lost  his  office,  then  contracted  debts, 
and  was  finally  reduced  to  live  upon  charity.  He  lived  in  a  garret  devoting  his 
whole  time  to  political  reading  and  writing,  and,  though  in  the  city,  he  kept  so 
much  secluded  that  the  revolution  of  July  1830,  was  effected  without  his  know- 
ledge. After  this,  some  one  gave  him  to  understand  that  Charles  the  Tenth  and 
his  family  had  married  him  to  the  Duchess  of  Berri.  He  was  then  confined  as 
a  prisoner  of  state  in  the  Bicetre,  but  Charles  X.  and  Louis  Philippe  still  pro- 
tected him,  and  Dupin,  President  of  the  Chamber  of  Deputies,  as  well  as  many 
other  eminent  personages  was  interested  in  him.  He  knew  that  he  had  the  pro- 
tection of  M.  Dupin,  because  some  one  had  pronounced,  before  him,  the  words 
*  Dupin;  there  is  Dupin.'  This  idea  probably  originated  from  hearing  around 
him,  the  words  '  du  pain^^ — bread.  He  had  other  associations  of  ideas  as  de- 
void of  foundation.  The  sight  of  a  knife  or  fork  recalled  to  his  mind  a  Jesuit 
General,  his  mortal  enemy;  and  that  of  some  other  object,  a  protector  or  friend. 
For  his  governmental  project,  he  was  given  to  understand  that  he  should  receive 
500,000  francs,  or  25,000  francs  per  annum.  A  pinch  of  snuff  being  taken  in  his 
presence,  signified  that  the  25,000  francs  would  be  paid.  Finally,  he  always 
gave  the  left  hand,  because  a  man  of  liberal  principles  never  should  give  the 
right  hand.  It  required  to  remove  all  these  ideas,  but  I  succeeded,  by  attacking 
them  in  succession  as  they  were  discovered.  The  first  renounced  was  the  mar- 
riage with  the  Duchess  de  Berri.  One  day  I  learned  that,  contrary  to  order,  he 
had  written  letters  to  several  persons,  and,  reproaching  him  for  the  act,  demand- 
ed them  of  him.  They  were  of  a  political  nature,  and  in  one  of  them,  he  re- 
quested the  payment  of  the  500,000  francs.  I  ordered  the  douche,  and  gave  him 
a  paper  upon  which  I  had  written  as  follows:  '  I  forbid  M.  Theodore  to  write 
anything  in  relation  to  politics,  and  wish  him  to  inform  me,  in  writing,  what  he 
thinks,  1st,  Of  the  writing  that  he  sent  to  Charles  X.;  giving  his  reasons  for 
hjs  opinions  thereupon;  2d,  Of  the  500,000  francs  mentioned  in  the  letter  to 
M.  Laisne,  and  of  the  25,000  francs  of  which  he  had  spoken  in  another  place; 
3d,  Of  his  marriage  with  the  Duchess  de  Berri;  4th,  Of  the  august  protections 
by  which  he  is  surrounded;  5th,  Of  the  actual  state  of  his  reason  compared 
with  what  it  was  eight  years  since;  6th,  To  say  what  opinion  he  has  of  me.' 
He  gave  nearly  rational  answers  to  these  questions,  but  slipped  in  a  little  poli- 
tics, and,  in  relation  to  the  500,000  francs,  it  was  evident  that  his  opinion  was 
unchanged.  He  also  complained  of  his  treatment,  saying  that  he  was  thrown 
into  '  a  state  of  constant  trouble,  fear  and  trembling,  as  if  one  tore  his  flesh  with 
pincers.'     This  was  evidently  an  exaggeration,  for  there  was  no  comparison  be- 


J 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity.  385 

tween  the  former  anxiety  of  his  countenance  and  the  serenity  which  had  now 
become  habitual.  A  new  series  of  answers  being  required,  he  wrote  as  follows. 
1st,  I  avow  my  entire  inability  to  tell  the  object  of  the  writing  sent  to  Charles 
X.  I  was  not  competent  to  draw  up  a  paper  of  that  kind.  It  may  be  regarded 
as  a  piece  of  folly;  and  the  writing  ought  to  have  been  destroyed.  2d,  As  to 
the  500,000  francs;  it  was  I  who  conceived  the  idea  that  it  was  due  me,  and  I 
can  give  no  reasons  for  having  claimed  it.  3d.  The  marriage  with  the  Duchess 
de  Berri  was  a  vision  of  mine.  I  no  longer  think  of  it;  it  was  a  foolish  idea. 
4th.  The  august  protections  were  also  visionary.  Had  I  had  such  protectors, 
I  should  not  have  been  in  my  present  condition.  5th.  It  is  not  for  me  to  eulogize 
my  own  intellectual  powers.  I  am  not  astonished  that  two  physicians  should 
have  thought  me  incurable;  my  long-continued  exasperation  since  entering  the 
hospital,  is  sufficient  grounds  for  such  a  belief.  I  have  now  the  intention  to  do 
well,  from  motives  of  duty,  honour  and  conscience.  In  order  to  merit  the  bene- 
volent intentions  of  those  who  take  an  interest  in  me,  as  well  as  for  my  own 
satisfaction,  I  desire  to  act,  in  everything,  with  regularity.  6th.  I  have  always 
thought,  and  said  that  Mons.  Leuret  is  a  man  of  honour,  wishing  to  do  good, 
even  in  his  treatment  of  me.  I  have  only  disputed  the  means  employed.  The 
state  of  anxiety,  terror  and  trembling  into  which  I  have  been  thrown  by  what 
has  passed,  could  not  fail  to  give  me  this  opinion  in  regard  to  those  means.  I 
constantly  feel  as  if  my  flesh  were  being  torn  with  pincers.  I  cannot  describe 
the  state  into  which  the  circumstances  mentioned  have  thrown  me.'  Notwith- 
standing the  '  pincers'  which  tore  his  flesh,  he  continued  to  work  and  was  nearly 
always  in  good  humour.  Sometimes  he  tilled  the  ground,  and  sometimes  wrote 
in  the  office  of  the  Director  of  the  Bicetre.  He  conversed  easily  and  without 
restraint,  visited  the  people  employed  in  the  establishment,  dined  with  some  of 
us  occasionally,  and  made  himself  an  agreeable  companion.  I  could  not,  then, 
greatly  pity  his  griefs,  and  persisted  in  my  system  of  being  inflexible  in  regard 
to  everything  which  he  said  or  did  that  was  irrational,  and  of  encouraging  him, 
by  all  the  means  in  my  power,  when  he  did  well.  Eight  days  after  the  above 
answers  were  written,  Theodore  was  in  my  office  with  another  patient.  The 
latter  having  been  in  the  Belgian  campaign,  said  that  he  had  saved  the  lives  of 
two  of  the  king's  sons  at  the  siege  of  Antwerp,  and  that  Louis  Philippe  had 
sent  for  him  to  come  to  Paris  for  a  pecuniary  recompense.  He  also  claimed  the 
cross  of  the  Legion  of  Honour,  because  upon  hearing  a  bullet  pass  by  him,  he 
fell  to  the  ground  through  fear.  I  requested  Theodore  to  assist  me  in  undeceiv- 
ing this  man,  and  he  acquitted  himself  admirably.  When  the  patient  was  gone, 
Theodore  smiling  said  to  me,  '  You  have  made  me  pass  through  the  alembic;  you 
have  brought  me  to  make  the  most  severe  criticism  upon  my  own  conduct.'  Some 
time  after  this.  Dr.  Ferrus,  believing  him  well  enough  to  have  his  liberty,  dis- 
charged him.  Since  that  time  he  has  worked  in  a  wood-shop,  lived  economi- 
cally, and  saved  something.  He  is  happy  in  the  present,  and  cares  little  for  the 
future;  but  it  is  not  without  sadness  that  he  recollects  his  residence  at  Bicetre. 
He  is  still  engaged  in  politics,  and  has  recently  addressed  a  letter  to  the  French 
on  the  subject  of  affairs  in  the  East/' 

Class  5th. — Case.  "Anthony  F.,  ajtat.  37,  educated  in  the  most  rigid  prin- 
ciples of  the  Catholic  religion,  became  intemperate,  suffered  from  pecuniary  em- 
barrassment and  was  deprived  of  his  place  in  an  office  under  government,  at  a 
time  when  he  expected  to  be  advanced  to  a  higher  station.  This  grieved  him 
much.  He  afterwards  became  an  enthusiast  in  regard  to  the  Jacotot  system  of 
education,  and  indulged  the  fancy  that,  by  means  of  this  system,  he  should  be- 
come a  genius.  Full  of  vanity,  and,  at  the  same  time  a  drunkard  and  a  devotee, 
he  was  constantly  in  a  state  of  anxiety  and  agitation.  Condemning  his  faults 
with  the  severity  of  a  rigid  censor,  he  immediately  returned  to  them  through 
the  influence  of  an  irresistible  power.  He  became  insane,  and  was  brought  to 
Bicetre,  October  9th,  1837.  He  then  believed  himself  a  man  of  eminence; 
said  that  he  was  going  to  civilize  the  whole  world,  and,  notwithstanding  the 
mildness  of  his  character,  became  offended  against  those  who  doubted  his  genius. 
No.  VIII.— October,  1842.  33 


386  Reviews.  [Oct. 

Finding  argument  of  no  avail  with  him,  I  waited  several  days  to  see  the  effect 
of  isolation,  abstinence  from  wine  and  separation  from  the  Jacotists.  The  dis- 
ease then  remaining  unchanged,  I  gave  the  patient  occasion  to  become  offended 
with  me  and  had  him  conducted  to  the  bath.  When  he  was  in  the  bathing-tub, 
I  told  the  people  present,  that  the  man  whom  they  saw  there,  acting  in  opposi- 
tion to  his  religious  principles,  had  become  intemperate,  vain,  and  a  teller  of 
falsehoods;  that  he  had  pretended,  in  my  presence,  that  he  was  going  to  civilize 
the  world,  and  finally,  that  1  was  about  to  correct  him  of  his  errors.  I  gave  him 
the  douche.  The  effect  of  it  was  instantaneous;  the  patient  became  what  he 
was  before  the  attack,  renounced  his  pretensions,  and  promised  never  to  cherish 
them  again.  *  *  *  *  He  combatted  his  errors  by  arguments  as  convinc- 
ing as  I  could  have  adduced  myself,  and  again  promised  not  to  indulge  in  them 
again.  He  kept  his  word,  remained  a  month  longer  in  the  asylum,  and  was  then 
discharged,  restored.     His  insanity  has  not  returned,  since  he  left." 

Class  6/A.— Case.  "  B.,  setat.  31  years,  entered  Bicetre  May  13th,  1839.  After 
having  led  an  intemperate  and  licentious  life,  he  married  and  entirely  reformed 
his  conduct.  Twenty  days  before  his  entrance  he  was  much  afflicted  by  the 
death  of  a  brother,  and  his  intellectual  faculties  soon  became  disordered.  He 
stopped  working,  and  suffering  an  additional  grief  from  anxiety  for  his  wife, 
who  had  a  laborious  accouchement,  his  insanity  was  increased.  Finally,  the 
attempted  revolution  of  the  12th  and  13th  of  May  gave  the  last  blow  to  his  rea- 
son. The  14th  of  May  he  was  pretty  calm,  but  very  loquacious;  said  he  had 
been  proclaimed  Emperor  of  the  French,  but  the  Parisians  preferred  the  present 
king  to  him.  The  attempted  revolution  was  in  his  favour;  he  was  sure  of  being 
triumphant,  and  was  going  to  take  the  name  of  Bonaparte,  the  Caesar  of  Cae- 
sars, &c.,  would  rebuild  Paris,  and  pave  the  streets  with  silver  and  gold.  He 
was  immediately  placed  under  the  douche  and  reproached  for  the  falsehoods  he 
had  uttered  with  such  sang-froid.  A  reprimand  and  the  douche  made  him 
renounce  his  ambitious  views.  In  the  evening  he  again  maintained  that  he  was 
Napoleon.  The  douche  in  the  morning  had  been  of  but  short  duration,  because 
he  yielded  with  the  greatest  facility.  It  was  now  renewed  and  prolonged. 
While  it  was  running,  B.  disavowed  all  his  absurd  ideas,  acknowledged  that  he 
was  but  a  poor  locksmith,  and  made  the  finest  promises.  The  next  day  he  was 
no  longer  Napoleon,  but  he  was  a  minister,  and  distributed  places  and  honours 
to  those  who  wanted  them.  Another  douche  and  renewed  promises.  On  the 
fourth  day  he  dissimulated  before  us,  but  to  the  attendants  said  he  was  Minister 
of  the  Interior.  Being  sent  to  the  bath-room,  he  denied  that  he  had  claimed 
that  title.  During  several  of  the  following  days  he  talked  but  little,  and  not 
irrationally.  Being  asked  if  he  was  Napoleon,  he  said  they  were  making  fun 
of  him,  that  he  had  forever  renounced  his  foolish  pretensions,  and  that  his  treat- 
ment had  done  him  much  good.  The  25th  he  should  leave  Bicetre,  through  the 
agency  of  his  uncle,  who,  he  said,  was  physician-in-chief  to  the  king.  Being 
submitted  to  the  douche,  he  retracted  these  assertions.  From  that  time  he  never 
talked  irrationally.  On  the  31st,  an  attempt  was  made  to  ascertain  whether  he 
still  indulged  his  former  ideas.  A  person  from  another  division  came  and  talked 
with  him  in  regard  to  his  pretensions.  The  stratagem  did  not  succeed  in  making 
him  again  maintain  them.  He  said  they  were  all  foolishness;  he  would  not 
hear  them  spoken  of;  he  was  insane  when  he  had  advanced  them.  Subsequently, 
he  was  submitted  to  other  similar  trials,  without  falling  into  his  former  errors. 
On  the  19th  of  June  he  was  discharged  perfectly  restored." 

This  case  was  reported  by  M.  Thore,  by  whom  it  was  treated  in  the 
absence  of  Dr.  Leuret. 

We  have  been  compelled  very  much  to  abridge  the  foregoing  cases,  but 
have  retained  everything  v/hich  had  an  important  bearing  upon  the  treat- 
ment. The  practice  advocated  and  pursued  by  Leuret  may  be  sufficiently 
comprehended  from  them.     The   system,  we  think,  will  appear  to  the 


1842.]  Leuret  on  the  Moral  Treatment  of  Insanity,  387 

teader  to  savowr  too  much  of  the  old  method  of  physical  restraint,  coer- 
cion and  punishment,  a  method  which  is  now  generally  regarded  as  funda- 
mentally erroneous.  It  is  not  our  intention,  for  we  do  not  feel  qualided  to  do 
it,  either  to  commend  or  to  condemn  the  system  as  developed  in  the  work 
before  us.  The  author  himself,  not  having  escaped  the  censure  of  some 
of  his  countrymen,  attempts  his  own  justification,  and,  to  say  the  least, 
there  is  much  cogency  in  his  arguments. 

"Some  have  believed,  or  pretended  to  believe,  that  in  my  opinion,  moral 
treatment  consists  in  violently  attacking,  at  once,  the  sentiments  and  passions 
of  the  insane;  in  inflicting  corporeal  pain,  and  resorting  to  intimidation.  I  have 
never  thus  understood  the  treatment  of  insanity,  and  have  said  nothing  which 
could  justify  the  belief  that  such  was  my  opinion.  Pain,  it  is  true,  constitutes 
a  part  of  the  treatment  which  I  recommend,  but  to  say  that  I  employ  it  in  all 
cases  is  to  advance  an  assertion  that  is  refuted  by  both  my  writings  and  my 
practice."— P.  156,  157. 

*'  When  I  have  provoked  unpleasant  ideas,  it  has  been  with  the  object  of  pre- 
ventins:  others  still  more  unpleasant^  of  leading  to  the  search  for  happiness,  and  of 
giving  it.  Sometimes  I  have  rendered  irrational  ideas  painful  in  order  to  make 
the  patient  reject  them;  and,  in  such  cases,  have  always  been  careful  to  suggest 
others  conformable  to  reason,  and  to  endeavour  to  give  them  the  attractions  of 
pleasure.  Am  I  in  error"?  I  think  not,  even  if  I  had  failed  in  my  efforts:  but  I 
have  been  censured,  although  I  succeeded  in  them." — P.  157-8. 
itii  ,  ''Remember  that,  at  the  bedside  of  a  patient,  you  are  not  there  as  a  man,  but 
as  a  physician;  and  that  what  is  expected  from  you  is  not  useless  attentions, 
politeness,  and  kind  actions  alone,  but  a  cure.  Whatever  it  may  cost  you,  have 
the  firmness  of  the  surgeon.  Your  instruments  are  the  passions  and  ideas;  learn 
how  to  use  them,  and  fear  not  to  call  to  your  aid  all  that  are  necessary."    P.  127. 

"  If,  to  withdraw  the  attention  of  a  monomaniac  from  the  ideas  which  con- 
stantly prey  upon  his  mind,  gentle  means  are  found  to  be  useless,  must  v;e  con- 
tinue to  employ  those  means  rather  than  resort  to  irony,  or  even  to  reproaches 
and  quarrelling'?  What  is  it  to  me  whether  a  lunatic  love  or  hate  me,  whether 
he  believe  me  his  friend  or  his  persecutor,  provided  that  I  break  the  chain  of  his 
false  ideas,  and  awaken  passions  which  will  wrest  him  from  the  passions  that 
characterize  his  disease.  My  object  is  not  to  cure  by  a  given  remedy,  but  by 
Any  possible  remedy.  And  if,  to  effect  this,  it  be  necessary  to  appear  severe,  or 
even  unjust  towards  him,  why  should  I  recoil  from  such  a  means'?  Should  I  fear 
lest  it  would  occasion  pain?  Singular  pity!  Tie,  then,  the  arm  of  the  surgeon 
who  is  about  to  perform  an  operation  necessary  to  save  the  life  of  his  patient; 
for  this  operation  cannot  be  performed  without  giving  pain!  A  man  has  the 
stone; — stuff"  him  with  gum-water;  cover  him  with  poultices,  instead  of  remov- 
ing, by  a  painful  operation,  the  cause  of  all  his  pain.  Consolations  to  some 
monomaniacs  are  like  gum-water  and  poultices  to  a  patient  who  has  the  stone." 
—P.  120-21. 

"Let  a  physician  who,  like  Broussais  and  Calmeil,  attributes  monomania  to 
a  circumscribed  phlegmon  of  the  brain,  apply  a  mora  to  the  head,  there  would 
be,  in  such  a  prescription,  no  barbarity,  no  corporeal  rigour:  the  moxa  would  be 
applied  very  rationally^  and  would  be  a  part  of  what  would  not  fail  to  be  called 
methodical  treatment.  But  let  a  physician,  avowing  that  he  knows  nothing  of 
the  nature  and  seat  of  the  disease  to  be  treated,  endeavour  to  combat  ideas  by 
ideas,  and  passions  by  passions;  let  him  administer  the  douche,  or  merely 
threaten  to  administer  it,  in  order  to  make  the  patient  renounce  his  hallucina- 
tions, and  from  that  moment  he  ceases  to  act  according  to  the  received  method; 
he  practises  cruelty.  Such  is  certainly  an  unjust  conclusion.  I  am  astonished 
}        that  men,  of  whom  the  profession  is  to  cure  people  who  reason  falsely,  should 

»  themselves  fall  into  so  palpable  a  contradiction." — P.  164-5. 
Dr.  L.  may  rest  satisfied,  that  if  his  system  be  superior  to  that  at  pre- 
sent in  vogue,  criticism  cannot  overthrow  it.     If  it  be  inferior,  it  ought  to 
be  so  far  condemned  as   to  prevent  its  adoption,  and  he,  as  a  sincere 


388  Reviews.  [Oct. 

searcher  for  the  truth,  should  rejoice  in  the  result.  Whatever  may  be 
true  iu  regard  to  the  general  views  of  the  author,  his  work  contains  many 
valuable  hints  which  we  have  not  met  with  in  any  previously  published 
treatise  upon  the  subject.  P.  E. 


Art.  XXI. — Medidnische  Stafistik  der  innerlichen  Jlbtheilung  des  Catha- 
rinen-Hospitales  zu  Stuttgart,  in  seinem  ersten  Decennium,  1828 — 
1838.  Von  Dr.  Georg  Cless.  Mit  einer  Lithographic  und  sieben 
Tabellen.     Stuttgart:  Verlag  von  Ebner  &  Seubert,  1841. 

Medical  Statistics  of  the  Interior  Division  of  the  Catharine-Hospital  at 
Stuttgart,  during  its  first  decennium,  1828 — 1838.  By  Dr.  George 
Cless.  With  one  lithograph  and  seven  tables.  Stuttgart:  Ebner  & 
Seubert,  1841,  quarto,  pp.  96. 

The  Catharine-Hospital  at  Stuttgart  is  so  called  from  the  circumstance 
of  being  dedicated  to  Queen  Catharine.  The  edifice  was  commenced  in 
1820,  and  completed  in  1827.  The  institution  is  divided  into  an  Hospital 
and  a  Lying-in  establishment,  there  being  connected  with  the  latter  an 
obstetrical  school.  The  Hospital  itself  is  divided  into  the  internal  and  the 
surgical  departments,  each  being  under  distinct  medical  control.  The 
inner  division,  to  which  belong  also  all  cases  of  chronic  cutaneous  erup- 
tions, of  syphilitic  diseases,  and  of  ophthalmic  surgery,  has  21  rooms  and 
132  beds;  but  in  case  of  emergency,  150  patients  can  be  very  easily  accom- 
modated. Children  under  eight  years  of  age,  and  all  labouring  under 
mental  diseases,  are,  by  a  regulation  of  the  institution,  excluded  from  its 
walls.  In  cases  which  prove  incurable,  the  patient  is  generally  allowed 
to  remain  three  months  in  the  hospital,  when  he  is  sent  either  to  his  native 
place,  or  to  the  city  infirmary  devoted  to  the  incurable  and  superannuated. 
A  claim  to  admittance  into  this  Hospital  is  possessed  by  all  servants,  jour- 
neymen, and  other  labourers  of  the  town,  who  have  made  themselves  lia- 
ble for  the  payment  of  a  yearly  sum,  each  to  what  may  be  called  his  own 
beneficial  society.  Further,  all  the  poor  who  are  natives  of  Stuttgart,  as 
well  as  all  poor  foreigners,  whether  residents  of  Stuttgart,  or  merely  tra- 
velling through  it,  are  entitled  to  the  benefits  of  the  Hospital  free  of 
expense.  The  Catharine-Hospital  was  opened  on  the  9th  of  January, 
1828;  and  ever  since  its  establishment.  Dr.  Cless,  the  father  of  the  author, 
has  been  the  physician  to  the  inner  division.  Accurate  tables  are  kept  of 
all  cases  admitted,  in  which  are  recorded  the  name,  age,  condition,  place 
of  nativity,  and  the  period  of  admission  and  discharge  of  every  patient;  and 
at  the  end  of  every  year,  an  annual  report  in  detail  is  presented. 

Medical  statistics,  it  is  truly  remarked  by  Dr.  Cless,  can  be  successfully 
cultivated  only  within  hospitals;  and  he  adds,  with  equal  truth,  that  it  is  a 
matter  of  special  wonder  to  see  how  very  few  have  availed  themselves  of 
these  advantages.  If  we  except  the  statistics  furnished  by  military  hospi- 
tals, the  contributions  to  medical  science  from  this  mode  of  investigating 
diseases  is  limited  indeed. 

We  will  now  endeavour  to  present  the  principal  results  of  the  author, 
confining  ourselves  to  points  of  general  interest.  Following  the  division 
of  the  subject  adopted  by  Dr.  Cless,  we  will  first  bring  under  notice  the 
sum  total  of  the  admissions  during  the  ten  years.  These  amount  to 
12,431,  of  which  6,414  were  males,  and  6,017  females.     It  may  be  wor- 


1842.]  Medical  Statistics  of  the  Stuttgart  Hospital,  389 

thy  of  remark,  that  the  annual  totals  exhibit  a  gradual  increase,  with  the 
exception  of  the  year  1836-7,  which  gives  the  maximum  in  consequence 
of  the  prevalence  of  the  ^^Grippe-EpidemieJ'^  This  gradual  increase 
speaks  much  in  favour  of  the  good  management  of  the  institution,  a  con- 
clusion corroborated  by  the  fact  that  whilst  in  the  first  year  the  proportion 
of  males  to  females  was  nearly  as  3  to  1,  the  ratio  in  subsequent  years  gra- 
dually attained  an  equality. 

The  number  of  days  of  sickness  for  each  admission  averages  nearly 
twenty-four,  it  being  in  the  earlier  years  of  the  establishment  of  the  hos- 
pital from  22  to  25  days,  but  in  more  recent  ones  only  18  to  21.  This 
reduction  the  author  ascribes  to  an  improved  mode  of  treating  scabies,  a 
disease  which  was  at  all  times  very  prevalent  in  the  hospital. 

The  fifth  chapter  treats  of  the  relative  monthly  morbility  and  the  influ- 
ence of  the  seasons  in  the  production  of  diseases.  The  monthly  morbility, 
on  an  average  of  thirty  days,  stands  thus; — 

.Tan.    1091  April  1706  July  1063  Oct.    856 

Feb.  1105  May    1007  Aug.  1040  Nov.  984 

Mar.  1154  June  1122  Sept.   858  Dec.  855 

It  thus  appears  that  we  find  the  maximum  of  disease  in  March,  followed 
in  the  descending  scale  by  June,  February  and  January.  The  minimum 
occurs  in  December,  followed  in  the  ascending  scale  by  October,  Septem- 
ber and  November.  These  monthly  results,  however,  are  considerably 
modified,  if  those  years  in  which  epidemics  prevailed  are  excluded  from 
the  calculation.  Thus,  if  the  year  1835,  v/hen  a  mucous  fever  epidemic 
[Schleim  fieher  epidemic)  prevailed  in  September  and  October,  is  thrown 
out,  the  mean  morbility  of  these  two  months  will  be  lower  than  that  of 
December.  In  like  manner,  as  the  ^'  Grippc-Epidemie'^  prevailed  very 
extensively  in  March,  1837,  the  exclusion  of  this  year  would  place  that 
month,  which  is  the  maximum,  below  January,  February  and  June. 

As  regards  the  relative  influence  of  the  seasons,  assuming  autumn  as 
100,  winter  gives  112,  and  spring  and  summer  each  120.  In  this  division 
of  the  seasons,  December  is  the  first  winter  month;  but  by  changing  it  so 
as  to  commence  the  winter  with  January,  the  result  is  so  much  modified 
that  winter  becomes  the  most  insalubrious  season.  The  morbility  of 
autumn  being  represented  by  100,  that  of  summer  is  equal  to  110,  that  of 
spring  117,  and  that  of  winter  122.  Making  three  divisions  of  the  year, 
the  first,  (January  to  April,)  has  4,441  cases;  the  second,  (May  to  August,) 
4324;  and  the  third,  (Sept.' to  Dec.,)  8609.  Lastly,  in  a  division  of  six 
months,  the  first  give  6,593  cases,  and  the  last  six,  5,781. 

As  respects  the  relative  mortality  of  the  seasons  as  deduced  from  the 
data  afforded  by  the  Catharine-Hospital,  we  find  the  season  of  summer  the 
most  salubrious.     The  ratios  are  as  follows: — 

Winter,  (December  to  February,)  108 

Spring,  (March  to  May,)  103 

Summer,  (June  to  August,)  86 

Autumn,  (September  to  November,)  123 

This  result,  so  far  as  the  summer  is  concerned,  is  confirmed  by  the 
data  furnished  by  the  church  register  of  Stuttgart  during  the  same  period 
of  ten  years,  the  relative  salubrity  of  the  seasons  having  the  following 
order — summer,  autumn,  winter  and  spring.  The  statistics  of  deaths 
among  the  adult  population  of  Berlin  give  results  somewhat  similar,  sum- 

33* 


390  Revieivs,  [Oct. 

mer  being  the  most  healthy  season,  and  winter  the  least  salubrious.    From 
July  1832  to  July  1838,  the  results  are  as  under; — 

Winter,  (December  to  February,)  6,735 

Spring,  (March  to  May,)  6,152  ,^. 

Summer,  (June  to  August,)  5,080  *.♦ 

Autumn,  (September  to  December,)  6,151 

We  have  been  the  more  particular  in  giving  these  results,  in  order  to  be 
enabled  to  institute  several  comparisons.  We  find  that  the  order  of  salu- 
brity, as  regards  the  seasons,  corresponds  very  nearly  with  that  of  Lon- 
don, at  the  present  day,  as  determined  by  the  "  registrar-general  of  births, 
deaths,  and  marriages,"  the  relative  unhealthiness  of  the  seasons  standing 
thus — winter,  spring,  autumn,  summer.  But  the  higher  or  lower  ratio  of 
the  seasons  in  different  regions  would  seem  to  have  an  inseparable  relation 
with  malarial  causes.  As  the  diseases  regarded  as  of  malarial  origin  are 
dominant  in  southern  Europe,  so  we  find  the  relative  salubrity  of  the  sea- 
sons, according  to  the  rule  laid  down  by  the  Greek  and  Roman  authorities, 
nearly  the  reverse  of  that  of  London,  and  of  the  Catharine-Hospital  at 
Stuttgart.  The  aphorism  of  Celsus  runs  thus — saluherrimum  ver  est, 
proxime  deinde  ah  hoc,  hiems,  periculosior  aestas,  autumnus  periculossi- 
mus.  In  the  United  States,  these  laws,  according  to  the  army  statistics, 
are  modified  in  accordance  with  the  prevalence  of  malarial  diseases.  Thus 
in  the  northern  states,  the  mortality  of  the  winter  months  is  generally 
equal  to  that  of  the  summer;  whilst  in  the  middle  and  southern  states,  the 
lowest  ratio  is  in  April,  from  which  month  it  gradually  increases  until 
September,  (the  difference  being  as  3  to  8,)  and  then  it  decreases  in  the 
same  unvarying  gradation  until  the  reappearance  of  April.  Even  in  our 
northern  cities,  as  Boston,  New  York  and  Philadelphia,  the  same  law 
holds  good;  but  these  effects,  except  in  cities  and  localities  decidedly  mala- 
rious, are  not  manifested  in  the  mortality  of  our  northern  regions,  owing 
to  the  circumstance  that  the  diseases  developed  by  malarious  causes,  such 
as  intermittent  fever,  unlike  the  violent  remittents  of  the  south,  do  not 
exert  a  fatal  tendency.  At  the  posts  in  the  malarial  region  of  the  great 
Lakes,  the  ratio  of  mortality  is  always  highest  during  the  summer,  whilst 
at  those  on  the  coast  of  New  England,  which  is  exempt  from  malarial 
causes,  there  is  litde  difference  in  the  ratio  of  cases  reported  each  quarter, 
the  winter  being  often  the  most  insalubrious  season.  At  Fort  Gibson,  on 
the  contrary,  the  ratio  of  sickness  is  twice  as  high  in  summer  as  in  win- 
ter. It  is  thus  seen,  that  under  the  same  laws  of  temperature,  very  diverse 
results  may  be  presented;  for  to  the  agricultural  inhabitants  of  a  non-mala- 
rial soil,  or  to  the  residents  of  a  city  equally  favourably  situated,  winter 
may  prove  the  most  unhealthy  season,  whilst  in  marshy  districts  or  cities 
abounding  in  dead  organic  matter,  summer  will  be  the  most  insalubrious. 

The  author  has  favoured  us  with  no  topographical  description  of  Stutt- 
gart; but  we  are  warranted  in  the  opinion  that  the  locality  is  but  slightly 
malarious,  from  the  circumstance  that  summer  is  the  most  healthy  season, 
and  winter  the  most  unhealthy.  Moreover,  the  general  table  of  diseases 
shows  the  comparative  infrequency  of  those  usually  regarded  as  of  mala- 
rial origin.  Thus  of  intermittent  fever,  there  are  reported  only  266  cases 
during  the  ten  years;  and  of  these,  111  occurred  in  the  spring.  Besides, 
more  than  one-half  of  these  cases  were  not  of  domestic  origin.  Of  remit- 
tent fever,  no  cases  are  registered;  but  of  "  febris  biliosa,"  there  are  211, 
and  of  dysenteria  only  142. 


1842.]  Medical  Statistics  of  the  Stuttgart  Hospital  391 

Of  the  admissions  into  the  Catharine-Hospital,  one  out  of  every 
29tVo  ^i^^*  ^  l^Yge  proportion  of  the  diseases  which  occur,  however,  are 
such  as  are  seldom  or  never  fatal.  Among  a  total  of  12,431  cases,  for 
example,  there  are  2,434  of  scabies.  The  average  of  one  death  in  29 
admissions  is,  however,  a  very  low  ratio  when  compared  with  the  other 
hospitals  of  Europe.  Thus,  in  London,  the  average  of  St.  Thomas's  Hos- 
pital is  one  in  sixteen,  and  of  St.  George's  Hospital,  one  in  nine.  At 
Edinburgh,  the  ratio  is  one  in  sixteen;  and  among  thirteen  hospitals  in 
Paris,  it  varies  from  one  in  5j%  to  one  in  33.  At  Amsterdam,  it  is  one  in 
10;  at  Pavia,  one  in  11;  at  Bologna,  (Tomassini's  Clinique,)  one  in  8;  at 
Palermo,  one  in  8;  at  Berlin,  one  in  6;  at  several  hospitals  in  Russia,  it 
varies  from  one  in  9  to  one  in  10;  and  among  eight  of  these  institutions  in 
Germany,  the  highest  average  is  one  in  six,  and  the  lowest,  one  in  twenty- 
five. 

The  next  subject  brought  under  notice  is  the  influence  of  different  avo- 
cations on  health  and  mortality.  This  investigation  is  conducted  after  the 
manner  of  Dr.  Fuchs,  of  Wiirzburg,  whose  researches  embrace  the  period 
from  1786  to  1834.  The  subjects  of  this  branch  of  the  statistics  of  Dr. 
Cless  consist  wholly  of  apprentices  and  journeymen;  and  as  the  former 
make  up  the  great  mass,  the  influence  of  trades  upon  health  and  mortahty 
is  the  more  happily  illustrated.  As  connected  with  this  subject.  Dr.  C. 
has  arranged  in  a  tabular  form  the  following  data: — In  column  first  is 
exhibited  the  total  of  each  craft  who  have  the  privilege  of  this  hospital,  in 
consideration  of  a  periodical  contribution;  in  column  second  is  given  the 
total  of  the  admissions  of  each  trade;  in  the  third  the  deaths  of  each;  in 
the  fourth  and  fifth,  the  ratio  of  morbility  and  of  mortality  in  reference  to 
the  totals  of  the  first  column;  and  in  the  sixth  column,  the  mortality  rela- 
tive to  the  number  of  each  trade  admitted. 

The  total  of  these  periodical  contributors  is  18,437,  of  whom  5,095 
were  admitted  as  patients,  and  153  died.  The  ratio  of  mortality  to  the 
admissions  is  hence  1  in  33y^. 

It  would  be  interesting  to  pursue  the  author  in  his  details  relative  to  each 
trade;  but  we  must  content  ourselves  with  some  general  remarks.  Dr. 
Cless's  results  fully  confirm  the  subjoined  conclusion  of  Dr.  Fuchs: — 
*'  Trades  that  require  much  confinement  within  doors  are  universally 
unhealthy;  whilst  such  as  demand  a  frequent  change  between  the  house 
and  the  open  air,  are  most  conducive  to  the  maintenance  of  health. 
Amongst  those  whose  occupation  is  continually  in  the  open  air,  the  low- 
est degree  of  morbility  is  presented;  but  it  is  with  these  trades,  on  the 
other  hand,  that  the  mortality  is  highest.  This  immunity  of  the  last 
against  ordinary  sickness  is  ascribable  to  their  being  inured  to  atmospheric 
changes,  whilst  the  high  mortality  arises  from  the  same  causes  when  act- 
ing with  much  intensity."  This  illustrates  the  different  influence  of 
trades,  as  regards  their  locality.  Thus  amongst  those  working  in  the 
open  air  are  included  carpenters,  masons,  stone-cutters,  etc.  Amongst 
those  constantly  confined  within  doors,  are  printers,  book-binders,  turners, 
dyers,  tinners,  potters,  hatters,  workers  in  gold  and  silver,  button-makers, 
tailors,  saddlers,  weavers,  etc.  And  those  trades  that  partake  of  the  cha- 
racter of  both  are  tanners,  glnziers,  chimney-sweepers,  coopers,  butchers, 
blacksmiths,  rope-makers  and  wheelwrights. 

In  reference  to  temperature  and  moisture,  a  like  difference  is  observable. 
A  warm  and  a  moist  atmosphere  operates  in  the  most  friendly  manner 


392  Hevietvs,  [Oct, 

upon  the  system  of  the  workman;  but  a  cold  and  damp  air  exercises  an 
opposite  tendency.  Those  that  labour  in  a  hot  and  dry  atmosphere  have 
a  higher  ratio  of  sickness  than  under  ordinary  atmospheric  circumstances, 
but  these  diseases  are  less  fatal.  These  results  are  also  in  confirmation  of 
those  of  Fuchs.  Those  tradesmen  that  work  in  a  dry  and  warm  atmo- 
sphere, characterized  by  a  high  morbility  and  a  low  mortality,  are  the 
several  kinds  of  smiths,  as  coppersmiths,  cutlers,  nailsmiths,  locksmiths, 
instrument-makers,  workers  in  gold  and  silver,  &c.  The  operatives  that 
work  in  a  warm  and  moist  atmosphere,  having  both  a  low  morbility  and 
mortality,  are  bakers,  brewers,  soap-boilers,  &c.  Those  whose  occupa- 
tion confines  them  to  a  cold  and  damp  atmosphere,  the  agency  of  which  is 
very  detrimental,  are  weavers,  printers,  &;c.;  but  the  term  cold  is  here  not 
used  in  an  absolute  sense,  but  as  relative  to  the  preceding  class  of  trades. 

The  next  results  show  the  influence  of  different  trades  upon  health  and 
mortality,  arising  from  the  materials  with  which  the  workmen  are  engaged. 
These  are  divided  into  dust,  vapours,  and  emanations.  Thus  stone-cut- 
ters, masons  and  smiths  live  in  an  atmosphere  filled  with  mineral  particles; 
bakers,  chimney-sweepers,  and  rope-makers,  in  one  with  vegetable  parti- 
cles; and  saddlers,  furriers  and  hatters  breathe  an  atmosphere  rife  with  ani- 
mal particles.  But  these  foreign  substances,  if  we  except  those  that  have 
a  mineral  origin,  seem  to  exercise  no  unfavourable  influence  upon  the 
Imman  constitution.  This  investigation  is  continued  in  reference  to  mine- 
ral vapours,  and  emanations  of  animal,  vegetable,  and  metallic  origin. 

Lasdy,  the  results  presented  elucidate  the  influence  of  different  trades  in 
reference  to  the  demand  made  upon  man's  physical  powers.  These 
authorize  the  conclusion,  though  not  entirely  confirmed  by  the  extensive 
researches  of  Fuchs,  that  the  most  laborious  trades  are  the  most  healthful, 
but  that  the  cases  which  occur  among  this  class  are  more  fatal  than  among 
those  trades  which  require  less  exercise  of  man's  strength. 

If  we  divide  the  various  trades  into  three  classes,  the  first,  or  the  most 
healthful,  comprise  the  following  in  the  order  of  their  position: — Workers 
in  gold  and  silver,  butchers,  bakers,  blacksmiths,  and  bookbinders.  The 
second  class,  or  those  of  medium  healthfulness,  is  the  following: — Car- 
penters, glaziers,  wheelwrights,  tailors,  coopers,  saddlers,  tanners,  lock- 
smiths and  weavers.  The  third  class,  or  those  which  prove  most  inju- 
rious to  the  constitution,  are  masons,  stonecutters,  printers,  coopers, 
instrument-makers,  (mechanical  and  optical,)  shoemakers  and  joiners. 
The  injurious  tendency  of  the  last  two  trades,  which  show  the  highest 
ratio  of  morbility  and  mortality,  are  attributable  to  the  circumstance  that 
these  operatives  are  wholly  confined  within  doors,  besides  being  sedentary 
and  constantly  in  a  doubled-up  position. 

In  the  fourteenth  chapter,  the  author  treats  of  the  morbid  diatheses, 
(Krankheits  constitutionem,)  which  prevailed  during  the  decennium. 
By  morbid  diathesis  is  meant  the  prevalence  of  a  particular  disease,  or  a 
class  of  diseases.  The  most  prevalent  is  the  gastric  diathesis,  which 
appeared  every  year  with  the  ingress  of  spring,  and  continued  until  the 
beginning  of  winter.  Nearly  half  the  cases  of  fever  reported  are  under  the 
name  of  *'  febris  gastrica;"  and  these  prevailed  mostly  during  the  warmer 
months.  Next  come  the  nervous,  the  bilious  erysipelatous,  the  choleric, 
and  the  dysenteric  diatheses.  The  inflammatory  diathesis  appeared  every 
year  at  the  period  of  the  lowest  winter  temperature;  and  the  degree  of  its 
intensity,  and  the  time  of  its  continuance  always  bore  a  close  relation  to 


1842.]  Medical  Statistics  of  the  Stuttgart  Hospital.  393 

the  intensity  and  continuance  of  cold  weather.  Between  the  period  of  the 
inflammatory  diathesis  of  winter,  and  the  gastric-bilious  of  summer,  both 
in  the  spring  and  fall,  the  catarrhal  and  rheumatic  diatheses  prevailed. 

The  fifteenth  chapter  is  devoted  to  the  epidemics  which  prevailed  dur- 
ing the  ten  years.     They  are  the  following: — 

1830— Autumn— Scarlet  Fever. 
1831 — Summer — Influenza  or  Grippe. 
1833 — Spring — Rubeola  and  Influenza. 
1834 — Summer — Cholera  and  Dysentery. 
1835— Autumn — Mucous  Fever. 
1836— Summer— Dysentery. 
1837— Spring— Influenza  or  Grippe. 
1837 — Autumn — Rubeola. 
1838 — Spring — Autumn. 

Of  these  eleven  epidemics,  not  a  single  one  occurred  in  the  season  of 
winter.  Of  the  three  epidemics  of  influenza  or  the  grippe,  it  was  only  in 
the  last  that  any  cases  proved  fatal  in  the  Hospital,  nine  having  died  from 
the  supervention  of  inflammation  of  the  lungs. 

In  the  last  space  are  presented  the  statistics  of  special  diseases. 

Under  the  head  of  fever,  our  author  condenses  all  the  cases  reported 
under  the  names  of  bdious,  gastric,  mucous  and  nervous  fevers,  regarding 
them  all  as  merely  modifiications  of  the  same  morbid  process,  arising  from 
diflference  in  the  intensity  of  the  cause,  and  from  peculiarity  of  constitu- 
tion. Under  the  same  category,  he  even  includes  typhus  fever,  the  do- 
thinenteritis  of  the  French.  The  cases  of  fever  make  up  more  than  one- 
seventh  of  all  the  diseases  reported,  and  the  mortality  from  this  cause 
constitutes  more  than  one-fourth  of  the  aggregate  of  deaths.  Every  fatal 
febrile  case  arose  from  typhus,  there  being  118  deaths  among  461  patients. 
As  regards  the  relative  influence  of  the  seasons,  we  find  that  the  highest 
ratio  of  cases  of  each  form  of  fever,  with  the  exception  of  typhus,  is  pre- 
sented in  the  summer;  but,  contrary  to  what  might  be  expected,  the  ave- 
rage of  typhus  in  winter  is  the  lowest.  The  ratio  of  cases  of  typhus 
stands  thus: — spring  107,  summer  99,  autumn  160,  and  winter  93. 

After  treating  seven  other  forms  of  disease,  our  author  takes  up  the  sub- 
ject of  intermittent  fever,  intimating  very  plainly  by  giving  it  a  position 
between  small-pox  and  chlorosis,  that  he  did  not  regard  it  as  possessing  a 
single  analogy  in  common  with  the  forms  of  fever  just  brought  under 
notice.  Of  this  disease  only  266  cases  are  reported;  and  of  these,  more 
than  one-half  were  contracted  in  localities  remote  from  Stuttgart.  It  was 
only  in  one  year  of  the  decennium,  (1835,)  that  intermitting  fever  evi- 
denced a  decided  endemic  character.  Of  remittent  fever,  no  cases  were 
registered. 

The  results  of  pleuritis,  pneumonia,  and  catarrhal  fever,  show  that  these 
diseases  are  much  under  the  influence  of  the  seasons.     Thus: — 


W^inter, 

Spring. 

Summer. 

Autumn, 

Catarrhal  Fever,     248 

201 

62 

114 

Pneumonia,             190 

154 

55 

56 

Pleuritis,                 156 

120 

137 

84 

Total,  594  475  254  254 

These  results  are  in  conformity  with  those  furnished  by  the  statistics  of 
the  United  States  Army;  and  this  fact  in  connection  with  several  others. 


394  Reviews.  [Oct. 

completely  exposes  the  fallacy  of  the  conclusion  deducted  from  the  Bri- 
tish army  statistics,  that  pulmonary  diseases  are  uninfluenced  by  the  laws 
of  temperature  pertaining  to  different  climates.  The  universal  opinions  in 
regard  to  the  advantages  of  change  of  climate  in  certain  forms  of  pulmo- 
nary afi*ections,  maintained  since  the  days  of  Hippocrates,  cannot  be  sub- 
verted by  the  unauthorized  deduction  of  the  British  army  statistics,  that  it 
is  "  by  no  means  likely  that  any  beneficial  influence  can  be  exerted  by 
climate  itself"  in  pulmonic  lesions. 

Phthisis  Pulmonalis. — These  cases  are  reported  under  two  heads,  viz. 
tabes  pulmonalis  and  phthisis  pulmonalis.  Under  the  former  are  included 
cases  in  their  incipient  stage,  and  also  those  of  chronic  catarrh;  and  under 
the  latter,  the  cases  of  confirmed  tubercular  phthisis,  characterized  by  soft- 
ening and  ulceration.     The  cases  reported  are  as  under: — 

Tabes  pulmonalis,         208  men  and  34  women,  making  243 
Phthisis  pulmonalis,     117    "      "     34        "  "         151 

Totals,        325  68  393 

Of  these  there  died  110,  85  men  and  25  women,  all  occurring  in  the 
class  of  phthisis  pulmonalis.  The  ratio  of  deaths  from  this  cause  (110), 
compared  with  the  total  mortality  (420),  is  as  1  to  3.81,  being  among 
males  1  to  3.05,  and  among  females  1  to  6.40. 

From  an  examination  of  the  church-register  at  Stuttgart  during  the  same 
period,  1828 — 1838,  excluding  all  deaths  in  individuals  under  fourteen 
years  of  age,  Dr.  Cless  obtained  the  following  results  relative  to  the 
mortality  from  pulmonary  consumption: — 

Deaths  from  all  causes.  Deaths  from  Consumption. 

Men        Women  Men        Women 

2071  2285  518  406 


4356  924 

The  ratio  of  deaths  from  consumption  among  the  adults  of  Stuttgart  com- 
pared with  the  total  mortality  is  consequently  one  in  4.71,  being  amongst 
males,  one  in  3.61,  and  amongst  females,  one  in  5.62.  Thus  whilst  in 
the  Catharine-Hospital,  a  little  more  than  a  fourth  of  all  the  deaths  arise 
from  pulmonary  phthisis,  the  ratio  among  the  population  of  Stuttgart  is  nearly 
as  low  as  one-fifth.  This  difference,  however,  admits  of  explanation  on 
the  ground  that  tubercular  diseases  would  be  more  apt  to  prevail  among 
the  class  who  become  the  inmates  of  an  hospital  than  among  the  general 
population  of  a  city;  but  the  difference  may  be  actually  still  greater,  as 
some  diseases  may  have  been  introduced  into  the  above  table  relative  to 
Stuttgart  that  do  not  fairly  belong  to  pulmonary  phthisis,  inasmuch  as 
Dr.  Cless  included  in  his  list  of  consumption,  not  only  those  reported  as 
Schivindsucht,  but  likewise  auszehrung^  lungensucht,  and  zehrjieber. 

Our  author  continues  his  comparisons  with  the  results  obtained  from 
other  hospitals,  and  from  the  bills  of  mortality  of  other  cities.  Thus  in 
Berlin,  the  proportion  of  deaths  from  pulmonary  consumption  to  the 
whole  mortality  is  as  I  to  4.95;  in  Hamburg,  as  1  to  3.4;  in  Montpelier, 
as  1  to  3.3;  in  Strasburg,  as  1  to  2.84;  in  London,  as  1  to  4.86;  and  in 
Edinburgh,  as  1  to  7.  Hence  it  appears  that  the  mortality  from  this  cause 
in  Stuttgart,  is  little  different  from  the  results  given  in  other  places. 

The  reports  of  the  Registrar-General  of  Great  Britain  confirm  this  result. 


1842.]  Medical  Statistics  of  the  Stuttgart  Hospital.  395 

Thus  in  the  following  table  are  given  the  number  of  deaths  caused  by- 
phthisis  in  each,  100  deaths  happening  in  England  and  Wales  in  both  sexes 
separately,  and  in  their  aggregate: — 

Years.  Males.  Females.  Both  sexes. 

1837  19.08     21.5       20.23 

1838  17.4     29.9       19.15 

1839  17.5     19.2       18.65 

Mean  17.99  20.73  19.36 

It  thus  appears  that  nearly  one  in  every  five  deaths  is  caused  by 
phthisis — a  result  that  coincides  with  that  just  given,  relative  to  London, 
viz.,  1  in  4.86. 

As  regards  the  comparative  tendency  to  phthisis  in  the  two  sexes,  the 
results  of  the  Catharine-Hospital,  as  has  been  already  seen,  show  that  the 
male  is  nearly  twice  as  liable  to  this  disease  as  the  female,  the  ratio  of 
deaths  from  this  cause  to  the  whole  mortality  being  in  the  former  1  in  3.05, 
and  in  the  latter  1  in  6.40.  In  Stuttgart,  according  to  the  table  given  on 
a  preceding  page,  these  averages  are  1  in  3.61,  and  1  in  5.62.  In  Berlin, 
the  difference  is  equally  striking,  that  of  males  being  1  in  4.23,  and  that 
of  females  1  in  6.26.  In  the  several  hospitals  of  Edinburgh,  during  the 
years  from  1833  to  1838,  a  similar  result  is  exhibited,  there  being  reported 
in  an  aggregate  of  2512  male  patients,  and  2749  female  patients,  185  cases 
of  phthisis  among  the  former,  and  112  among  the  latter.  This  law  as 
regards  the  comparative  tendency  to  phthisis  in  the  two  sexes  is  likewise 
confirmed  by  the  table  of  the  Registrar-General  given  above.  The  ratios 
being  17.99  to  20.73,  the  tendency  of  the  female  to  consumption  is  ex- 
pressed by  the  number  1.14,  that  of  the  male  being  taken  as  unity.  But 
this  calculation  of  Mr.  Farr  would,  doubtless,  be  more  accurate,  if  the  actual 
mortality  from  phthisis  in  the  two  sexes  were  compared  with  the  number 
of  persons  of  each  sex  living  at  the  time.  It  would  seem  then  to  be  an 
established  truth,  that  there  exists  a  greater  tendency  to  phthisis  among 
the  male  than  the  female  sex,  notwithstanding  the  opposite  conclusions  of 
M.  Louis  of  Paris. 

The  relative  influence  of  the  seasons  as  expressed  in  the  number  of 
admissions  and  of  deaths  in  each,  shows  that  tubercular  phthisis  is  not 
governed  by  the  same  laws  that  control  pneumonia,  pleuritis,  and  catarrh. 
The  statistics  of  the  Catharine-Hospital  give  the  following  results  as  regards 
the  number  of  admissions,  &c.  of  deaths.  Winter  81  cases  and  24  deaths; 
spring 23  cases  and  28  deaths;  summer  185  cases  and  25  deaths;  and  autumn 
82  cases  and  24  deaths.  It  is  thus  seen  that  in  respect  to  admissions,  the 
law  compared  with  that  of  pleuritis,  pneumonia,  and  catarrh,  is  nearly 
reversed;  whilst  in  reference  to  the  mortality  from  phthisis,  each  season 
presents  nearly  the  same  result.  At  Berlin,  among  4808  deaths  from 
phthisis,  2755  occurred  in  winter  and  spring,  and  2124  in  summer  and 
autumn.  At  Strasburg,  from  1819  to  1827,  among  1469  fatal  cases  of 
phthisis,  there  died  405  in  winter,  435  in  spring,  307  in  summer,  and  322 
in  autumn.  All  these  results,  however,  concur  in  showing,  though  the 
difference  is  small,  that  more  phthisical  patients  die  during  cold  weather, 
(winter  and  spring,)  than  in  the  warm  seasons  of  summer  and  autumn. 

Of  the  several  forms  of  phthisis,  it  may  with  good  reason  be  main- 
tained that  chronic  bronchitis^  as  regards  the  influence  of  the  seasons, 
belongs  to  the  category  of  pleuritis,  pneumonia,  and  acute  catarrh;  but 


396  Reviews.  [Oct. 

phthisis,  as  connected  with  a  tuberculous  state  of  the  constitution,  we 
regard  as  far  more  under  the  influence  of  other  causes.  In  England,  as  it 
has  been  satisfactorily  ascertained  that  the  maximum  of  liability  to  phthisis 
exists  among  those  who  suffer  the  least  exposure  to  climatic  variations,  it 
follows  that  the  influence  of  the  latter  must  be  considered  as  secondary  to 
the  action  of  other  causes,  as,  for  example,  occupation,  food,  and  habits. 
Although  it  cannot  be  doubted  that  a  changeable  climate  exercises  an  evil 
influence  on  constitutions  predisposed  to  phthisis;  yet,  as  we  find  that  the 
most  variable  climates  are  best  adapted  for  the  development  of  the  various 
mental  and  bodily  powers,  it  is  apparent  that  the  agency  of  this  cause  in  the 
production  of  phthisis  has  been  much  exaggerated,  or  much  too  exclusively 
considered.  Among  the  causes  which  we  regard  as  productive  of  the 
cachectic  condition  of  the  system  which  precedes  the  formation  of  tubercle, 
which  tends  to  destroy  the  balance  of  the  functions,  and  diminish  the  tone 
of  the  system,  thus  robbing  the  blood  of  that  rich  fibrinous  and  vital  con- 
dition, by  which  proper  nutrition  and  the  organic  functions  are  sustained, 
are, — unhealthy  air,  whether  from  closeness,  humidity,  or  impurities, — 
long-continued  exposure  to  extremes  of  temperature  as  connected  with  the 
seasons,  or  to  cold  alone  as  from  insufficient  clothing,  in  constitutions 
which  have  not  vascular  irritability  enough  to  induce  inflammation, — 
imperfect  nutrition,  whether  from  improper  or  deficient  food,  the  abuse  of 
spirituous  liquors,  or  from  lesions  of  the  digestive  or  assimilative  organs, — 
venereal  excesses, — repeated  courses  of  mercury, — profuse  and  very  debili- 
tating discharges,  or  their  sudden  suppression  when  habitual, — the  de- 
pressing passions,  as  disappointed  love,  distress  from  reverses  of  fortune, 
etc., — irregularities  of  the  uterine  function,  especially  when  of  a  chlorotic 
character, — adynamic  fevers,  as  well  as  the  exanthematous  forms  when 
followed  by  the  atonic  state. 

Peritonitis  and  Enteritis. — Of  252  cases  of  peritonitis,  84  occurred 
in  winter,  56  in  spring,  49  in  summer,  and  63  in  autumn.  The  monthly 
maximum  (39)  belongs  to  January,  and  the  minimum  (12)  to  May.  Com- 
paring the  number  of  cases  of  these  two  diseases  with  that  of  pleuritis  and 
pneumonia,  the  latter  is  more  than  three  times  greater  than  the  former;  and 
whilst  the  majority  of  the  inflammations  of  the  chest  occurred  amongst  men, 
(527  to  452,)  the  rule  in  the  abdominal  inflammations  is  more  than  reversed, 
being  226  female  cases  to  62  male.  The  mortality  from  the  former  amongst 
the  men  is  five  times  greater  than  from  the  latter,  being  20  and  4;  but 
amongst  the  women,  the  mortality  from  each  is  very  nearly  the  same.  The 
aggregate  of  the  cases  of  inflammation  both  of  the  thorax  and  abdomen, 
is  equivalent  perhaps  to  one-tenth  of  all  the  diseases  registered.  In  both 
classes,  the  maximum  of  cases  occurs  in  the  coldest  period  of  the  year. 

Rheumatism, — These  cases  are  reported  under  three  heads,  Viz.,  febris 
rheumatica,  rheumatismus  acutus,  and  rheumatismus  chronims.  There 
are  1079  cases  registered,  being  about  one-eleventh  of  the  aggregate  of 
cases;  but  the  proportion  in  the  two  sexes  is  very  unequal,  making  among 
females  one-eighth  of  all  their  diseases,  and  amongst  males  only  one-seven- 
tieth. The  relative  influence  of  the  seasons  in  the  etiology  of  these  affec- 
tions is  expressed  in  the  following  ratios. 

Winter.  Spring.  Summer.  Autumn. 

306  292  264  216 

But  it  is  only  the  *'  Febris  rheumatica'''  that  the  influence  of  the  seasons 


1842.]  Medical  Statistics  of  the  Stuttgart  Hospital.  ■  397 

is  decidedly  evidenced,  winter  being  198,  spring  193,  summer  150,  and 
autumn  125;  and  as  regards  the  months,  the  minimum  ,31,  occurs  in  Oc- 
tober, and  the  maximum,  77,  in  February.  "  Rheumatismiis  aciitus^' 
is  uninfluenced  by  the  seasons,  whilst  "  Bheumatismus  chronicus^^  has 
the  highest  ratio  in  summer.  Thus  no  season  is  exempt  from  some  form 
of  rheumatic  affection. 

Two  cases  proved  fatal,  one  on  the  supervention  of  inflammation  of  the 
lungs,  and  the  other  of  the  heart,  both  being  females. 

Erysipelas. — These  cases  are  arranged  under  Febris  erysipelatosa  and 
Erysipelas  faciei.  Of  both  there  occurred  373  cases,  of  which  117  were 
males  and  256  females.  The  fact  of  the  ratio  of  the  females  being  more 
than  twice  as  high  as  that  of  the  males,  is  not  extraordinary;  for,  accord- 
ing to  Frank,  the  proportion  is  as  4  to  1,  and  according  to  B.  Phillips  of 
London,  as  3  to  2.  Amongst  the  men,  the  bakers  give  a  higher  ratio  of 
erysipelas  faciei  than  any  other  trade.  No  case  terminated  fatally.  The 
treatment  consisted  of  antiphlogistic  purgatives,  without  emetics  or  stimu- 
lants. 

Chlorosis. — In  Stuttgart,  amongst  the  diseases  of  females,  this  is  one 
of  the  most  extensive  prevalence.  The  total  of  cases  is  358,  but  this  falls 
short  at  least  one-third  of  the  actual  number,  for  many  of  the  cases,  which 
were  involved  with  acute  diseases,  were  reported  under  the  latter  names. 
Dr.  Cless  estimates  that  at  least  one-twelfth  of  all  the  female  patients  ad- 
mitted into  the  hospital,  laboured  under  chlorosis.  It  is  a  general  impres- 
sion, adds  our  author,  that  chlorosis  and  its  kindred  afl"ection,  hysteria, 
pertain  almost  exclusively  to  the  higher  classes  of  society;  but  the  expe- 
rience of  the  Catharine-Hospital  shows  that  both  these  diseases  are  not 
less  prevalent  among  the  lower  classes,  such  as  hired  domestics,  than 
among  those  who  have  been  educated,  and  who  continue  to  live  in  the 
most  artificial  modes.  The  relative  influence  of  the  season,  in  the  produc- 
tion of  chlorosis,  is  expressed  by  the  following  ratios: — winter  77,  spring 
88,  summer  114,  autumn  87,  thus  showing  a  regular  connection  with  the 
increase  and  decrease  of  temperature. 

Scabies. — The  total  of  cases  of  this  disease,  2447,  is  remarkably  great; 
and  what  is  still  more  extraordinary  is,  that  2073  of  these  cases  occurred 
among  men,  and  only  374  among  women.  This  inequality  Dr.  Cless  ascribes, 
with  good  reason,  to  the  operation  of  external  causes,  independent  of  any 
constitutional  difference  in  the  sexes.  The  influence  of  the  seasons  in  the 
etiology  of  this  disease  is  not  very  marked;  but  winter  gives  the  highest 
average,  whilst  the  lowest  is  presented  by  the  months  of  August,  Septem- 
ber, October,  and  November.  The  connection  of  the  several  trades  with 
this  disease  is,  however,  more  strikingly  displayed  in  these  statistics,  as  is 
shown  by  the  total  of  each  trade  brought  under  treatment  compared  with 
the  total  of  the  same  trade,  who  are  members  of  what  may  be  called  a 
Beneficial  Society,  [Krankheitshostenversicherungshasse.)  The  trades 
yielding  the  lowest  ratios  of  itch,  are  tanners,  stonecutters,  and  masons, 
carpenters,  bakers,  workers  in  gold  and  silver,  butchers  and  printers;  and 
those  giving  the  highest  means,  are,  weavers,  shoemakers,  wheelwrights, 
tailors,  joiners,  turners,  and  bookbinders.  Thus  whilst  the  average  of  tan- 
ners is  but  1  in  52.7,  that  of  bookbinders  is  1  in  4.2.  These  various  results, 
doubtless,  arise  from  the  difl'erent  modes  of  living,  and  from  the  diverse 
external  relations  of  each  trade,  as  poverty,  uncleanliness,  living  crowded 
No.  VIII.—OcTOBER,  1842.  34 


398  Reviews.  [Oct. 

together,  and  especially  sleeping  together,  as  well  as  the  stuffs  among 
which  operatives  labour. 

That  bookbinders  should  give  a  ratio  as  high  as  1  in  4:^^  is  a  very  unex- 
pected result.  Believing  that  the  inequality  of  the  ratios  of  different  trades 
is  mainly  ascribable  to  the  nature  of  the  materials  employed  in  each,  our 
author  inclines  to  the  opinion  that  the  high  average  of  bookbinders  arises 
from  the  circumstance  that  their  hands  are  daily  covered  with  paste  and 
glue.  We  are  free  to  confess  that  the  relation  of  cause  and  effect  is  here 
beyond  our  comprehension.  Now  were  it  papermakers,  instead  of  book- 
binders, it  would  be  easy  to  refer  the  cause  of  the  disease  to  a  contagion 
lodged  in  the  rags  which  they  are  obliged  to  assort. 

It  is  a  remarkable  fact  that  among  all  the  workers  in  wood,  such  as  turn- 
ers, joiners,  and  wheelwrights,  a  ratio  next  to  that  of  the  bookbinders,  ob- 
tains, the  first  being  1  in  4.6,  the  second  1  in  5,  and  the  third  1  in  5.2. 
Dr.  Cless  asks — Can  the  glue,  as  in  the  case  of  the  bookbinder,  also  here 
exert  its  influence? 

Amongst  tailors,  the  ratio  of  itch  is  as  high  as  1  in  5.1,  a  result  at  which 
no  one,  in  the  opinion  of  our  author,  will  be  surprised.  "  They  ought  in- 
deed," he  says,  "  according  to  universal  opinion,  figure  in  the  front  rank; 
but  this  honour  our  statistics  do  not  entirely  award  them,  thus  permitting 
the  evil  renown  of  the  tailor  in  this  respect  to  appear  at  least  in  part,  as  a 
prejudice."  The  chief  source  of  the  disease  in  this  class,  independent  of 
the  material  in  which  they  work,  he  ascribes  to  the  crowded  state  in  which 
the  journeymen  tailors  live,  in  quarters  in  which  the  contagious  principle, 
like  the  sacred  fire  of  the  vestal  virgins,  is  never  extinguished. 

Shoemakers  and  weavers  come  next  on  the  list,  the  ratio  of  the  former 
being  1  in  5.5,  and  of  the  latter  1  in  5.9.  To  mention  a  few  more  in 
the  scale  of  ascending  exemption,  the  average  of  saddlers  as  1  in  8.3,  of 
coopers,  1  in  9.7,  of  soapboilers,  1  in  ll.l,  of  buttonmakers,  1  in  12.8, 
of  perukemakers,  1  in  15.2,  of  mechanical  and  optical  instrument-makers, 
1  in  18.3,  of  printers,  1  in  24.9,  of  butchers,  1  in  27.3,  of  workers  in 
gold  and  silver,  1  in  30.6,  of  bakers,  1  in  34.4,  of  carpenters,  1  in  38.5, 
of  masons  and  stonecutters,  1  in  46.8,  and  of  tanners,  1  in  52.7. 

In  these  last,  we  discover  the  influence  of  healthful  occupations  in  di- 
minishing the  prevalence  of  the  disease.  Among  tanners,  for  instance, 
who  give  the  lowest  average,  (but  4  cases  being  registered,  out  of  211 
entitled  to  the  benefits  of  the  hospital,}  the  very  material  in  which  they 
work,  doubfless,  acts  as  a  true  prophylactic.  The  stonecutter,  the  mason, 
and  the  carpenter,  are  no  doubt  indebted  for  their  comparative  immunity, 
partly  to  the  free  air  they  breathe,  and  partly  to  the  nature  of  their  work- 
ing material.  It  is  remarkable  that  the  baker  possesses  a  similar  exemp- 
tion, notwithstanding  his  frequent  liability  to  chronic  exanthems,  (lichen, 
eczema,  and  impetigo,)  on  the  hands  and  arms,  an  immunity  which  our 
author  ascribes  to  the  constant  application  of  flour  to  the  skin. 

We  have  thus  endeavoured  to  follow  Dr.  Cless  through  the  main  course 
of  his  investigations;  and  when  it  is  considered  that  the  data  and  conclu- 
sions he  presents,  are  the  result  of  years  of  observation  and  severe  mental 
toil,  our  readers,  we  trust,  will  concur  with  us  in  the  opinion  that  he  has 
rendered  a  service  to  humanity.  S.  F. 


1842.]  399 


BIBLIOGRAPHICAL  NOTICES. 


Art.  XXIL — The  History^  Pathology^  and  treatment  of  Puerperal  Fever  and 
Crural  Phlebitis,  I.  A  Treatise  on  the  Epidemic  Puerperal  Fever  of  Aberdeen. 
By  Alexander  Gordon,  M.  D.  II.  A  Treatise  on  the  Puerperal  Fever:  illus- 
trated by  cases  which  occurred  in  Leeds  and  its  vicinity^  in  the  years  1809-12. 
By  William  Hey,  Esq.  III.  Facts  and  observations  relative  to  the  Fever^  com- 
monly called  Puerperal.  By  John  Armstrong,  M.  D.  IV.  On  Puerperal 
Fever  and  Crural  Phlebitis.  By  Robert  Lee,  M.  D.,  F.  R.  S.  With  an  In- 
troductory Essay.  By  Charles  D.  Meigs,  M.D.,  &c.  Philadelphia:  1842. 
Barrington  and  Haswell,  8vo.  pp.  338. 

The  question  as  to  the  nature  and  treatment  of  childbed  fevers  being,  confess- 
edly, a  most  important  one,  the  present  reprint  of  the  valuable  treatises  of  Gor- 
don, Hey,  Armstrong  and  Lee,  in  a  form  calculated  to  place  them  within  the 
reach  of  every  member  of  the  profession  in  this  country,  cannot  fail  to  secure 
to  Dr.  Meigs,  in  common  with  the  editor  of  the  Select  Medical  Library,  in  the 
July  number  of  which  work,  these  treatises  are  comprised,  the  gratitude  of  a 
large  and  respectable  portion  of  their  medical  brethren;  especially  of  such  of 
them  as  are  most  liable  to  be  called  upon  to  prescribe  for  a  class  of  diseases, 
which,  more  perhaps  than  any  other,  require,  in  order  to  secure  a  favourable  re- 
sult, a  prompt  diagnostic,  and  the  early  resort  to  a  judicious  and  energetic  treat- 
ment. 

A  careful  study  of  the  volume  before  us,  is  unquestionably  calculated  to  afford 
much  important  information,  in  relation  to  the  history,  pathological  character,  and 
therapeutical  management  of  one  form,  and  that  by  no  means  an  unfrequent  one, 
of  the  fevers  to  which  puerperal  women  are  liable. 

Taken  in  connection,  the  treatises  it  comprises,  present  an  invaluable  mass  of 
facts  in  relation  to  childbed  fever,  without  an  acquaintance  with  which  no  one 
can,  with  propriety,  be  considered  fully  qualified  to  undertake  its  management. 

It  is  not  our  intention  on  the  present  occasion  to  attempt  a  review  of  these 
facts,  with  the  pathological  and  therapeutical  deductions  that  have  been  based 
upon  them.  The  few  remarks  we  feel  inclined  to  offer  will  have  more  especial 
reference  to  the  introductory  essay,  which  is,  in  many  points  of  view,  a  highly 
interesting  performance. 

We  fully  agree  with  Dr.  Meigs  in  the  general  estimate  he  has  expressed, 
of  the  value  of  the  several  treatises  before  us,  and  admit  that  a  strict  atten- 
tion to  the  directions  laid  down,  especially  by  Dr.  Gordon,  and  so  zealously 
enforced  by  Dr.  Meigs,  for  the  proper  use  of  the  lancet  in  puerperal  fever,  is 
essential  to  the  successful  treatment  of  that  form  of  the  disease  in  which  direct 
depletion  constitutes  the  only  safety  of  the  patient;  but  we  are,  nevertheless, 
somewhat  fearful,  that  the  earnestness  with  which  he  insists  upon  early,  full  and 
repeated  bleeding  as  the  sole  remedy  calculated  to  arrest  the  fatal  course  of 
puerperal  fever,  is  calculated  to  mislead  the  young  practitioner. 

It  is  an  all-important  question,  and  one  we  had  hoped  to  find  fully  discussed 
in  the  iessay  before  us — whether,  under  the  general  denomination  of  puerperal 
fever,  there  are  not  included  various  forms  of  disease,  which,  while  in  their 
external  physiognomy,  they  present  a  close  family  resemblance,  nevertheless 
differ  so  far  from  each  other,  in  their  true  pathological  character  as  to  demand 
a  very  essential  modification  in  their  treatment. 

It  must  be  evident,  that  until  this  question  is  decided,  everything  in  relation 


400  Bibliographical  Notices.  [Oct. 

to  the  treatment  of  the  disease  will  be  marked  by  uncertainty  and  confusion.  For 
if  it  be  shown  that  puerperal  fever  is  not  one  "  specific  disease,"  but,  on  the  con- 
trary, that  the  term  has  been  by  different  writers,  applied  to  affections  which 
"  vary  in  their  nature  and  treatment  as  much  as  other  kinds  of  fevers,"  (Lo- 
cock,)  it  is  absurd  to  argue  in  favour  of  any  general  plan  for  the  treatment  of 
puerperal  fever  from  the  success  that  has  attended  the  employment  of  this  or 
that  set  of  remedies  during  particular  epidemics. 

That  puerperal  fever  "occurs  under  different  forms,  each  of  which  is  subject 
to  a  good  deal  of  variety,  depending  upon  individual  peculiarity,  season  of  the 
year,  and  numberless  other  circumstances,"  (Rigby,)  and  that  these  different 
forms  and  varieties  call  for  an  appropriate  modification  in  the  plan  of  treatment 
to  be  pursued,  is  a  fact  recognised  by  nearly  all  the  recent  writers  on  the  dis- 
ease; and  one  fully  borne  out  by  the  results  of  our  own  personal  observations. 

Dr.  Lee,  in  the  essay  contained  in  the  volume  before  us,  observes,  that  "In 
the  treatment  of  puerperal  fever,  the  following  are  the  principal  objects  we 
should  keep  in  view.  First,  to  subdue  the  local  inflammation  of  the  uterine 
organs:  and  secondly,  to  moderate  the  constitutional  disturbance  vi'hich  the  local 
inflammation  invariably  produces.  In  fulfilling  these  indications,  no  exclusive 
plan  of  treatment  should  be  adopted;  but  we  ought,  according  to  the  peculiari- 
ties of  each  case  and  stage  of  the  disease,  to  employ  blood-letting,  mercury, 
opium,  cathartics,  diaphoretics,  blisters,  and  whatever  other  means  we  can  dis- 
cover to  possess  any  influence  in  controlling  the  disease. 

"  In  no  inflammatory  affection  of  the  internal  organs  are  the  good  effects  of 
blood-letting,  general  and  local,  more  strikingly  displayed  than  in  the  first  variety 
of  uterine  inflammation,  peritonitis;  but  the  results  of  my  experience  do  not 
confirm  the  accuracy  of  the  conclusions  drawn  by  some  authors;  that  in  all 
cases,  by  the  early  employment  of  these  means,  we  can  succeed  in  curing  the 
disease.  It  is  always  an  affection  attended  with  great  danger,  and  it  not  unfre- 
quently  runs  its  course  rapidly  to  a  fatal  termination,  in  spite  of  the  most  prompt 
application  of  remedies." — P.  282. 

"  With  regard  to  the  treatment  of  inflammation  of  the  uterine  appendages, 
and  of  the  deeper-seated  tissues  of  the  uterus  itself,  whether  of  the  absorbents, 
veins,  or  of  the  muscular  structure,  the  symptoms  from  the  commencement,  are 
generally  those  which  contraindicate  the  use  of  general  blood-letting.  In  cases 
where  the  reaction  at  the  invasion  of  the  disease  has  been  violent,  and  venesec- 
tion has  been  employed,  the  relief  obtained  has  only  been  temporary,  and  in 
some  instances  the  abstraction  of  a  small  quantity  of  blood  from  the  arm  has 
produced  alarming  syncope." — P.  288. 

Dr.  Collins  remarks,  that  "  The  extreme  difference  of  opinion,  and  the  very 
opposite  measures  recommended  by  practitioners,  arises  chiefly,  I  am  satisfied, 
from  their  treating  of  every  variety  of  puerperal  fever  as  one  and  the  same  dis- 
ease, whereas  there  is  perhaps  not  any  which  exhibits  a  greater  diversity  of  cha- 
racter in  different  situations,  and  even  in  the  same  situation,  at  different  periods. 
In  some,  the  fever  is  accompanied  by  symptoms  indicative  of  the  most  active  in- 
flammation, such  as  to  forbid  the  least  delay  in  the  free  use  of  venesection,  and 
the  decided  employment  of  antiphlogistic  measures.  This  form  of  disease,  W«cA 
is  hyfar  the  most  manageable^  is  generally  met  with  in  private  practice.  Puer- 
peral fever,  when  epidemic  in  hospitals,  is  directly  the  reverse;  at  least  in  four 
epidemics  which  I  have  witnessed,  the  symptoms  were  usually  of  the  lowest 
typhoid  description,  the  pulse  being  so  feeble  and  indistinct,  as  to  make  yon 
dread  in  many,  even  the  application  of  leeches;  the  patients  in  several  instances 
of  this  form  of  the  disease  exhibiting  somewhat  the  appearance  of  those  labour- 
ing under  cholera." 

It  is  remarked  by  Dr.  Locock,  that  "Dr.  Gordon,  Mr.  Hey,  and  Dr.  Armstrong, 
the  advocates  for  large  bleedings  in  all  cases  of  puerperal  fever,  because  they 
happened  to  see  epidemics  which  would  bear  it,  and  demanded  it,  have  said  that 
the  fatality  of  the  low  puerperal  fever  of  London  must  have  arisen  from  timidity 
and  not  pushing  bleeding  to  a  sufficient  extent;  that  however  feeble  and  rapid. 


1842.]  Puerperal  Fever  and  Crural  Phlebitis.  401 

the  pulse,  bleeding  was  the  only  remedy  to  be  depended  upon,  and  that  the  pulse 
would  rise  on  the  loss  of  blood.  An  oppressed  pulse  would  certainly  do  so  in 
many  instances,  but  there  is  a  certain  and  important  difference  between  the  op- 
pressed and  really  feeble  pulse,  though  many  can  with  difficulty  distinguish  the 
one  from  the  other.  The  earliest  experience  of  the  writer  in  puerperal  fever  was 
in  two  distinct  and  well-marked  epidemics  in  the  spring-  of  1822.  From  the 
decided  advantage  of  copious  bleeding  in  the  first,  we  were  naturally  led  to  push 
what  is  commonly  called  bold  practice  in  the  first  cases  of  the  second,  but  the 
result  soon  proved  our  rash  mistake.  These  adynamic  cases  will  not  bear  bleed- 
ing favourably — a  very  few  ounces  will  soon  produce  fainting,  followed  by  rapid 
collapse.  It  should,  however,  be  kept  in  mind,  that  in  an  epidemic  of  this  de- 
scription, cases  of  an  opposite  character  occasionally  occur.  Women  of  robust 
constitutions,  previous  to  the  attack  in  comfortable  circumstances,  and  accus- 
tomed to  a  generous  diet,  may  have  the  active  form  of  the  disease,  while  dozens 
of  patients  are  suffering  under  the  other  form  in  the  same  ward." 

A  similar  statement  as  to  the  different  and  dissimilar  forms  under  which  puer- 
peral fever  may  present  itself,  and  the  consequent  difference  of  treatment  de- 
manded for  its  cure  is  made  by  Dr.  Rigby  in  the  excellent  account  presented  by 
him  of  the  pathology  and  treatment  of  puerperal  fevers,  in  his  recent  system 
of  midwifery. 

Dr.  Meigs,  in  the  enthusiastic  recommendation  of  the  lancet  in  the  early  stage 
of  puerperal  fever,  evidently  assumes  as  an  undeniable  proposition,  that  blood- 
letting, well  timed  and  carried  to  a  proper  extent,  is  an  essential  and  generally 
successful  remedy,  in  all  cases  of  disease  attended  with  evident  symptoms  of 
local  inflammation,  and  that  its  necessity  is  always  in  proportion  to  the  extent 
and  violence  of  such  inflammation. 

After  presenting  a  general  view  of  what  he  esteems  to  be  the  nature  of  the 
diseases  comprised  under  the  term  childbed  fever,  he  asks,  (page  17,)  what  are 
great  inflammations  that  they  can  be  overcome  "  by  means  of  a  iew  drugs  ap- 
plied to  the  mucous  coat  of  the  stomach  or  bowels;  by  some  cataplasms  or  lini- 
ments, or  fomentations  to  the  belly;  or,  at  most,  by  dozens  or  hundreds  of 
leeches  fixed  on  the  cutis  of  the  abdomenl" 

"  Especially  inflammations  concealed  in  the  very  recesses  of  the  body,  remote 
from  the  surfaces,  and  deriving  their  source,  their  impetus,  their  proximate 
cause,  their  ipsissima  causa,  from  the  injective  power  of  arteries  springing  di- 
rectly from  the  emulgents,  the  aorta,  or  the  hypogastric  tubes.  It  would  appear 
to  me  to  be  mere  dawdling  with  the  malady,  in  comparison  with  the  vigorous 
and  masterful  influences  of  blood-letting,  which  is  perfectly  obedient  to  the  will 
of  the  physician,  goes  directly  to  its  object,  and  stops  short  at  the  desirable 
point;  which  reduces  the  injecting  force  of  the  systemic  ventricles,  and  brings 
it  to  such  a  state  as  to  leave  the  necessary  equipoise  between  all  the  parts  of  the 
angiotenic  apparatus:  a  therapeutic  agent,  which,  wisely  and  well-directed  to 
the  exigencies  of  the  case,  surpasses  all  other  modes  of  relief  or  cure." 

"To  bleed  in  fevers  and  inflammations,  is  to  lessen  them."  Happy  would  it 
be  for  our  patients  did  we  possess  an  agent,  such  as  blood-letting  is  described  by 
Dr.  Meigs,  capable  of  controlling,  so  eflfectually  and  certainly  every  form  and 
variety  of  inflammation.  Unfortunately,  experience  too  certainly  proves  that 
such  is  not  the  case.  Inflammation,  hovt'ever  evident  or  wide  extended  it  may 
be,  is  often  so  essentially  modified  by  certain  causes,  of  the  exact  nature  and 
action  of  which  we  are  not  always  cognisant,  as  to  render  the  employment  of 
blood-letting  a  doubtful,  if  not  improper  remedy. 

"  Inflammation,"  remarks  a  recent  writer  (Clutterbuck),  "  and  the  employment 
of  blood-letting  are  often  so  strongly  associated  in  the  minds  of  practitioners,  that 
the  presence  of  the  one  is  apt  immediately  to  suggest  the  idea  of  a  necessity  for  the 
other.  From  the  same  cause  it  is  that  in  diseases  the  nature  of  which  is  obscure 
and  questionable,  it  has  been  sometimes  argued  that  the  disease  was  not  inflam- 
mation, merely  because  it  did  not  yield  to  blood-letting— as  if  this  were  a  univer- 
sal remedy  for  inflammation,  and  applicable  at  all  times  and  on  all  occasions. 
Instead  of  this  being  the  case,  however,  I  must  repeat  to  you  that  there  are  a 

34* 


402  Bibliographical  Noticed,  [Oct 

great  number  of  inflammations  which  blood-letting  will  not  cure;  many  also  in 
which  though  useful,  it  may  be  safely  and  properly  dispensed  with;  and  not  a 
few  in  which  it  proves  injurious  rather  than  beneficial." 

That  blood-letting  is  neither  a  certain,  essential  nor  proper  remedy  in  every 
form  of  puerperal  fever,  even  where  the  existence  of  local  inflammation  is  un- 
questionable, is  a  fact  confirmed  by  the  result  of  our  own  experience.  Wo  have 
lately  witnessed  an  epidemic  of  puerperal  fever  of  a  highly  malignant  character, 
during  which  the  effect  of  early  and  copious  bleedings  was  very  fully  tested.  In 
no  one  instance,  however,  were  they  found  to  arrest  the  progress  of  the  disease 
— on  the  contrary,  in  many  cases,  they  appeared  rather  to  accelerate  the  occur- 
rence of  the  stage  of  fatal  collapse. 

There  can  be  no  doubt,  that  when  puerperal  fever  is  dependent,  chiefly,  upon 
acute  peritoneal  inflammation,  active  depletion  by  the  lancet,  promptly  resorted 
to,  and  carried  to  a  proper  extent  is  the  only  remedy  capable  of  effectually  control- 
ling the  disease,  and  ensuring  a  favourable  result.  This  form  of  fever  is  the  one 
commonly  met  with  in  private  practice,  and  not  unfrequently  occurs  epidemically. 
"  It  is,"  remarks  Locock,  "that  which  has  been  described  by  Dr.  Gordon,  Dr. 
Armstrong,  Mr.  Hey,  and  others;  and  although  much  more  fatal  when  epidemic 
than  when  in  a  sporadic  form,  is,  when  taken  in  time,  most  under  the  control  of 
remedies." 

It  is  to  be  regretted  that  no  approach  has  yet  been  made  towards  the  establish- 
ment of  an  accurate  diagnosis  of  the  several  forms  of  puerperal  fever.  Were  it  pos- 
sible always  "  to  trace  the  connection  between  the  peculiarity  of  the  symptoms  and 
the  morbid  changes,  it  would  simplify  our  knowledge  of  the  disease,  and  in  time 
improve  the  treatment."  But,  unfortunately,  writers  have  heretofore  contented 
themselves  with  "  merely  describing  the  peculiar  form  of  disease  which  had 
come  under  their  own  notice,  and  to  which  they  have  exclusively  awarded  the 
name  of  puerperal  fever;  an  error  in  judgment  which  has  led  to  still  greater 
errors  in  practice,  and  which  has  certainly  tended  to  prevent  the  subject  being 
so  clearly  understood  as  it  might  have  been.  The  mode  also  in  which  it  has 
been  investigated  by  modern  authors  has  been  but  of  little  assistance  in  disclos- 
ing the  true  features  of  that  disease;  they  have  indeed  rather  tended  to  mislead 
than  to  guide  us,  they  have  directed  our  attention  to  certain  effects  of  it  which 
they  have  considered  to  be  the  disease  itself,  and  thus  rather  conceal  than  dis- 
close the  real  natura  morbi,^^ — (Rigby.)  D.  F.  C. 


Art.  XXIII. — Specimen  Medicum  Inaugurale,  de  Morbosa  Gazorum  Secretione, 
Auctore  J.  L.  Siemens.     Groningen,  1841:  8vo.  pp.  64. 
On  the  Morbid  Secretion  of  Gases.     By  J.  L.  Siemens. 

The  subject  of  the  present  dissertation  is  one  of  no  little  interest.  That  the 
tissues  of  the  living  body,  as  well  during  health  as  disease,  separate  various 
gases  from  the  blood  by  a  process  analogous  to  secretion,  is  a  fact  either  fully 
or  indirectly  admitted  by  most  if  not  all  modern  physiologists;  while  by  a  long 
list  of  distinguished  pathological  writers,  instances  are  recorded  of  gases- being 
detected  within  the  cranium,  in  the  cavities  of  the  pleura,  the  pericardium  and 
peritoneum,  in  the  gall  and  urinary  bladders,  the  uterus,  the  cellular  tissue,  the 
blood-vessels  and  intestinal  canal,  under  circumstances  which  render  it  very 
difficult  to  account  satisfactorily  for  their  production,  excepting  by  a  vital  pro- 
cess closely  resembling  that  of  secretion. 

It  is  somewhat  remarkable,  however,  that  the  subject  of  the  secretion  of  gases 
by  the  living  tissues,  whether  as  a  healthy  or  diseased  process,  has  never  been 
satisfactorily  investigated,  nor  the  facts  bearing  upon  the  question  carefully  col- 
lated and  compared. 

John  Hunter,  in  his  observations  on  digestion,  long  since  asserted,  as  "an 
undeniable  fact,"  that  "air  is  either  formed  from  the  blood,  or  let  loose  by  some 
action  of  the  vessels,  both  naturally,  and  from  disease;" — a  proposition  which, 


M842.]  Siemens  on  Morbid  Secretion  of  Gases.  403 

although  denied  by  many  later  writers,  has  never  yet  been  satisfactorily  dis- 
proved. 

P.  Frank  has  treated  of  the  subject  at  some  length,  and  adduced  striking 
instances  of  spontaneous  emphysema  from  the  secretion  of  gas  in  the  subcuta- 
neous cellular  tissue.  Similar  cases  are  also  related  by  Gendrin  and  Baillie;  a 
very  interesting  one  is  likewise  reported  in  the  Lanceite  Francaise  for  1828. 

Gendrin,  as  well  as  Portal  and  Laennec,  notice  cases  of  emphysematous 
tumours  in  the  pia  mater,  upon  the  surface  of  the  corpora  striata,  and  beneath 
the  arachnoides. 

Cases  of  simple  pneumo-thorax  from  the  secretion  of  gas  within  the  cavity  of 
the  chest  are  related  by  Gendrin,  Laennec,  Andral,  Frank,  and  others.  Very 
recently  a  very  interesting  paper  on  this  subject,  comprising  cases  in  evidence 
of  the  secretion  of  air  into  the  cavity  of  the  pleura,  was  published  by  Dr.  Graves, 
of  Dublin;  while  the  existence  of  pneumo-thorax  from  this  cause  is  also  fully 
admitted  by  Dr.  Williams  in  his  work  on  diseases  of  the  chest. 

Cases  of  gas  secreted  into  the  cavity  of  the  pericardium  are  given  by  Portal, 
Laennec,  Louis,  Albers,  Hope,  Testa  and  others. 

Bubbles  of  gas  have  been  observed  in  the  blood-vessels  of  the  brain  in  cases 
related  by  Morgagni,  Lieutaud,  Fabricius,  Portal,  Zuliani,  Berends,  Sebastian, 
and  in  the  vessels  of  other  portions  of  the  body  by  Friedreich,  Chiarugi,  Littre, 
Testa,  Phobus,  Krombholz,  Perier,  Coudougens,  Villerme,  and  RebolTe. 

The  fact  of  the  secretion  of  air  in  the  alimentary  canal  is  maintained  by 
John  Hunter,  Baumes,  Frank,  Stokes,  Andral,  Magendie,  Gerardin,  Belg  and 
others.  Lobstein  attempts,  by  a  series  of  no  very  conclusive  arguments,  to 
prove  that  the  gases  ordinarily  contained  in  the  intestines,  are  the  result  of  a 
secretory  process.  It  is  asserted  by  M.  Siemens  that,  when  a  portion  of  intes- 
tine, entirely  emptied  of  its  contents,  is  included  between  two  ligatures,  after 
some  hours  it  becomes  distended  with  gas.  Gendrin  informs  us  that,  when 
in  animals  inflammation  was  excited  in  the  mucous  membrane  of  a  convolution 
of  intestine  by  the  application  of  diluted  ammonia,  boiling  water  or  alcohol,  and 
the  part  included  between  ligatures,  on  the  day  subsequent,  the  enclosed  por- 
tion of  intestine  was  found,  in  two  cases  out  of  five,  to  be  distended  by  an  inodo- 
rous gasiform  fluid.  Sebastian  performed  similar  experiments,  and  with  the 
same  results. 

Although  pneumatosis  of  the  abdomen,  from  the  generation  of  air  within  the 
general  cavity  of  the  peritoneum,  has  been  denied  by  Abercrombie  and  other 
authoritative  writers,  we  have,  nevertheless,  sufficient  evidence  of  its  not  unfre- 
quent  occurrence,  if  we  place  any  confidence  in  the  recorded  observations  of 
Heister,  Lieutaud,  Albers,  Bell,  Gendrin,  Stoerck,  Frank,  Schulor  and  Graves. 
In  the  Lancette  Francaise  for  1828,  two  interesting  cases  are  related  of  an  eff"u- 
sion  of  gas  beneath  the  mucous  membrane  of  the  stomach  and  small  intestines. 
The  generation  of  air  within  the  cavity  of  the  uterus  is  noticed  by  numerous 
writers.  John  Hunter  adduces  this  fact  as  an  evidence  of  the  power  possessed 
by  the  living  organs  of  secreting  or  separating  aeriform  fluids  from  the  blood. 
Cases  of  the  accumulation  of  gas  within  the  uterus,  or  of  its  expulsion  per  vagi- 
nam,  are  recorded  by  Eisenmenger,  Palfin,  Fernelius,  Denman,  Andral,  and 
Szerlechi.  A  curious  instance  is  related  by  Dr.  Ray  in  the  February  number  for 
1833  of  this  Journal,  of  the  discharge  of  flatus  per  vaginam,  as  well  during  preg- 
nancy as  in  the  intervals;  and  a  well-marked  case  is  quoted  from  the  Medico- 
Chirurg.  Transactions  of  Bologna  in  Boivin  and  Duges  Traite  Pratique  des 
Maladies  de  I'uterus,  t.  1. 

Cases  are  related  by  Berger,  Bartholine,  Frank  and  Lobstein  of  the  discharge 
of  gas  by  the  urethra,  and  the  latter  writer  narrates  an  instance  in  which  the 
gall-bladder  was  distended  with  gas,  without  any  obstruction  in  the  common 
duct. 

The  preceding  brief  references  comprise  but  a  small  portion  of  the  facts  record- 
ed by  different  writers,  having  a  more  or  less  immediate  bearing  upon  the  ques- 
tion of  the  secretion  of  gas  by  the  tissues  of  the  living  body  during  health  and 
disease.    The  whole  subject  is  one  which  requires  a  more  full  and  careful  exa- 


404  Bibliographical  Notices,  [Oct. 

mination  than  it  has  yet  received,  while  it  certainly  involves  many  points  of  suf- 
ficient importance  to  invite  to  it  the  attention  of  the  physiological  as  v^ell  as 
pathological  inquirer. 

]n  the  dissertation  of  M.  Siemens  vrill  be  found  a  very  good  digest  of  the 
principal  materials  for  the  investigation  of  the  question  as  to  the  production  of 
gases  in  various  diseased  conditions  of  the  tissues,  collected  w^ith  commendable 
industry  and  tolerably  well  arranged.  The  author  has  not,  however,  availed 
himself  of  all  the  materials  within  his  reach;  neither  has  he  analyzed  with  suffi- 
cient care,  nor  made  the  best  use  of  those  which  he  has  collected.  Notwith- 
standing, we  consider  the  work  of  M.  Siemens  a  very  interesting  and  highly 
creditable  one,  it  is,  nevertheless,  true  that  he  has  failed  in  establishing  conclu- 
sively his  thesis.     We  still  consider  as  unsettled  the  important  questions: — 

1st.  Are  the  gases  which  exist  during  health  in  the  alimentary  canal,  sepa- 
rated from  the  blood  by  the  mucous  membrane  of  the  stomach  and  bowels? 

2d.  Are  the  gases  generated  in  the  several  cavities  of  the  body  during  certain 
states  of  disease  the  result  of  a  morbid  excretion! 

3d.  What  is  the  particular  pathological  conditions  during  which  the  genera- 
tion of  gases  takes  place] 

4th.  What  is  the  nature  of  the  gases  generated  in  disease;  do  they  vary  in 
different  cases  attended  by  similar  lesions,  or  do  the  same  gases  always  present 
themselves  during  particular  pathological  conditions  of  the  tissues? 

For  the  use  of  any  of  our  readers  who  may  be  inclined  to  undertake  a  more 
thorough  investigation  of  this  subject,  we  subjoin  the  following  bibliography. 

Andral. — Clinique  Medicale. 

Albers. — Erlauterungen  zu  dem  Atlasse  der  Path.  Anat.  1833,  p.  55 — Lehr- 
biich  der  Semiotik,  1834,  p.  535. 

Baillie. — Trans,  of  a  Soc.  for  the  Promotion  of  Med.  and  Chirurg.  Knowledge. 

Bell. — On  ulcers  and  Tumours,  vol.  2. 

Berger. — Collect.  Med.  Havniensis,  vol.  2,  p.  73. 

Bartholine. — Ibid. 

Bouillaud. — Diseases  of  the  Heart,  vol.  2. 

Baumes. — Lettres  sur  les  Causes  et'  les  Effects  de  la  presence  des  Gaz  ou 
vents  dans  les  voies  gastrique. 

Ibid. — Suite  des  Lettres,  &c.,  8vo.  pp.  94,  Paris. 

Camper. — Observationes  Pathologicoe,  vol.  2,  p.  16. 

Coudougnes. — See  Journ.  Hebdom.   1835. 

Chevillot. — Recherches  sur  les  Gaz  de  L'estomac  et  des  Intestins  de  I'homme 
a  I'etat  de  Maladie.   Thesis  republished  in  Gaz.  Med.  de  Paris,  7th  Sept.  1833. 

Denman.' — Introduction  to  the  Practice  of  Midwifery,  chap.  3,  §  10. 

Eisenmenger. — Collect.  Hist.  Foetus. 

Frank.— De  Curand.  Hominum  Morb.  1811,  lib.  vi,  §  705. 

Froriep's  Notizen,  July  1838,  p.  80. 

Fabricius.— Acta  Nat.  Cur.  X.  117. 

Friedreich. — Algem.  Diagnostik  des  Psych.  Krank.,  1832,  ii.  p.  181. 

Guisard. — Practique  de  Chirurg,  tom.  1,  p.  134. 

Gendrin. — Hist.  Anat.  des  Inflam.,  tom.  1,  p.  94,  et  seq. 

Graves. — Medico-Chirurg.  Review,  vol.  20,  p.  442. 

Hunter. — Animal  Economy,  Phil,  edit.,  p.  128,  et  seq. 

Heister. — W^ahrnehmungen,  I,  art.  15, 

Hope.— Diseases  of  the  Heart. 

Krombholz. — See  Jour.  Hebdom.  1835. 

Lieutaud. — Anat.  Med.,  i — iv. 

Laennec. — Traite  de  I'Auscultation,  1837,  tom.  2. 

Lobstein.— Traite  d'Anat.  Patholog.  1829,  i,  155-159. 

Littre.— Mem.  de  I'Acad.  des  Sci.,  1714,  p.  330. 

Morgagni. — De  Sed.  et  Cans.  Morb.  Epis.  v,  xxxviii. 

Monro.— Edin.  Med.  Essays,  vol.  1,  art.  31. 

Mayo. — Grundniss  der  Speciellen  Pathol.,  part  i,  p.  163, 

Palfin.— Descript.  des  Parties  de  la  Ferame,  1708. 


184^.]  Hoist  on  the  Influence  of  the  New  Penitentiary  System.        405 

Portal.— Anat.  Med.  iii,  p.  26. 

Obs.  sur  la  Nat.  et  le  Trait,  de  TApoplexie,  p.  358. 
Perrier. — See  Jour.  Hebdom.  1835. 
Rebolle. — See  Med.  Chiruro-.  Review,  vol.  20,  p.  445. 
Stoerck. — Annus  Medicus,  ii,  p.  123,  et  seq. 
Schuhr. — Schmidt's  Jahrbiich,  1841,  i,  p.  40. 
Szerlecki. — Ibid.,  1841,  iv,  ix. 

Sebastian. — Geneeskundige  Bijdragen,  1839,  §  22,  p.  27. 
Spitta.— Die  Liechenoffn,  1826,  p.  258. 
Stokes. — Clinical  Lectures — lee.  xi. 
Testa. — Delle  Malattie  del  Cnore,  vol.  2. 
Villerme.— Diet,  des  Sci.  Med.  torn.  3,  p.  364. 
Zuliani.— De  Apoplex.  Praes.  Nerv.  Comment,  1790,  §  26.  D.  F.  C. 


Art.  XXIV". — Om  de  Sanitaire  Forholde  i  Fsengskr  efter  nyere  Systemer.     Ved 

Professor  Frederik  Holst,  M.  D. 
The  Influence  of  the  New  Penitentiary  System  upon  the  Health  of  the  Prisoners. 

By  Professor  F.  Holst,  M.  D.     8vo.  pp.  30:  Christiania,  1840. 

In  every  system  of  penitentiary  discipline,  the  influence  it  may  exert  upon 
the  health  of  the  prisoners  demands,  unquestionably,  a  primary  consideration. 
However  excellent  it  may  be  in  other  respects,  if,  in  its  operation,  any  given 
system  be  found  actually  to  endanger  the  health  and  lives  of  those  who  become 
its  subjects,  every  dictate  of  humanity  would  call  for  its  immediate  rejection. 
Against  the  system  of  solitary  confinement  adopted  in  Pennsylvania  this  charge 
has  been  repeatedly  made,  and  as  itisone,if  true,  of  sufficient  force  to  cause  the  con- 
demnation of  the  system  on  the  part  of  every  enlightened  community,  it  demands 
a  full  and  candid  investigation.  The  validity  of  the  charge,  as  urged  against  the 
latter  system,  is  the  subject  of  inquiry  in  the  essay  before  us — an  inquiry 
prompted,  we  understand,  by  a  disposition  evinced  on  the  part  of  the  authorities 
of  Norway  to  introduce  into  their  prisons  such  reform  in  discipline  as  the  expe- 
rience of  other  countries  has  shown  to  be  best  adapted  for  the  prevention  of 
crime  and  the  reform  of  the  criminal. 

Dr.  Hoist,  in  the  performance  of  his  task,  has  evinced  as  much  zeal  as  can- 
dour, availing  himself  of  the  various  official  documents  that  have  appeared  in 
relation  to  the  new  system  of  penitentiary  discipline,  he  presents  a  very  full  and 
perfectly  fair  statement  of  all  the  facts  furnished  by  them,  calculated  to  show 
the  influence  which  the  several  modifications  of  the  system  of  solitary  confine- 
ment exert  upon  the  health  of  the  prisoners;  and  has  carefully  compared  the 
influence  of  the  system  as  thus  ascertained  with  that  of  prisons  in  which  the  plan 
of  solitary  confinement  has  not  yet  been  adopted. 

The  facts  we  as  yet  possess  bearing  directly  upon  the  question  are  compara- 
tively few  and  imperfect,  arising  from  the  short  time  during  which  the  system 
has  been  in  operation,  the  few  prisons  in  which  strict  solitary  confinement, 
according  to  the  Pennsylvanian  system,  has  been  introduced,  and  the  improper 
location,  and  defects  of  internal  arrangement  and  construction  of  several  of  these. 

Dr.  Hoist  has,  however,  made  the  best  of  the  materials  within  his  reach;  his 
inquiry  has  been,  to  all  appearance  at  least,  conducted  with  strict  impartiality, 
and  the  sole  desire  to  arrive  at  truth.  The  conclusion  at  which  he  arrives  is 
decidedly  in  favour  of  the  sanitary  character  of  the  solitary  confinement  of  pri- 
soners, according  to  the  Pennsylvania  system. 

It  would  give  us  great  pleasure  to  present  to  our  readers  a  sketch  of  the  lead- 
ing facts  and  arguments  of  Dr.  Hoist;  but  as  the  whole  is  based  upon  strict  sta- 
tistical details,  and  the  different  parts  of  the  investigation  bear  so  intimate  a 
relation  one  to  the  other,  we  should  find  it  extremely  difficult  to  do  entire  justice 
to  the  author,  or  present  the  subject  in  a  useful  form  before  our  readers,  unless 


406  Bibliographical  Notices.  [Oct. 

we  were  to  translate  over  two-thirds  of  the  essay;  we  must  content  ourselves, 
therefore,  with  the  translation  of  the  annexed  tables. 

The  first  exhibits  the  proportion  of  deaths  to  prisoners  in  various  prisons, 
upon  the  old  and  new  systems,  compared  with  the  ratio  of  mortality  among  the 
communities  generally  in  which  the  penitentiaries  are  located. 


Houses  of  Correction. 

Mortality  among 

General 

the  Prisoners. 

Mortality. 

1.  Old  System. 

{a)  France,          _             -             -             - 

- 

1  in  40 

Maisons  Centrales,     -            -      . 

1  in  21 

Bagnes,     -            -            -            - 

-  1  in  21 

Average      -            -            - 

1  in  22.5 

(a)  Belgium^       -             -             -             - 

- 

1  in  43 

Maisons  Centrales  since  1830, 

1  in  31.3 

2.  Auburn  System. 

(a)  America. 

Auburn,  1828-38,  11  years,  - 

1  in  54 

Singsing,  1832-38,  7  years. 

-  1  in  30 

Boston,  1818-35,  18       "       - 

1  in  20 

Baltimore,  1833-37,  5    " 

-  1  in  34 

1  in  47 

Average,     -            -            - 

1  in  34.5 

(6)  England. 

Coldbath  Fields,  1836-39,  3  years, 

-   1  in  30 

lin60 

Wakefield,  1835-36,  2  years, 

1  in  34.5 

Average,          -            -            - 

1  in  32.2 

(c)  Switzerland. 

Geneva,  1826-33,  8  years,     - 

1  in  58 

lin40 

1834-37,4      » 

1  in  25.7 

Lausanne,  1826-33,  8  " 

1  in  31.5 

1  in  39* 

Average,           -            -            - 

1  in  38.4 

3.  Philadelphia  System. 

(a)  .America. 

Cherry-hill,  1829-39,  11  years. 

1  in  26.75 

Pittsburgh,  1828-34,  7 

-    1  in  31 

Average,    -            -            - 

1  in  28.9 

lin41 

(b)   Great  Britain. 

Milkbank,  London, 

-    1  in  40 

Glasgow,  Scotland,  1835-37,  3  years,          1  in  55 

Average,    -            -            - 

1  in  47.5 

1  in  60 

(c)  Switzerland. 

Lausanne,  1834-37,  4  years. 

-    1  in  43 

1  in  39* 

The  second  table,  exhibits  the  ratio  of  mortality  among  the  prisoners  in  each 
class  of  the  penitentiaries  included  in  the  first  table,  compared  with  the  ratio  of 
mortality  in  the  communities  generally  in  which  they  are  located. 

*  Ratio  of  mortality  among  the  same  ages  of  the  people  genierally  as  of  those  who 
constitute  the  inmates  of  the  prison,  namely,  from  16  to  73  years. 


«   302 

u 

68  »  22.5   " 

«    72 

u 

43  "  59.7  « 

«    92 

u 

50  "  54  3  « 

«    17 

u 

5  "  29.4  « 

«    87 

(( 

40  "  45.9  « 

«    12 

(( 

5  «  41.6  « 

728 

271  or  37  per  cent. 

1842*.]   Hoist  on  the  Influence  of  the  New  Penitentiary  System,        407 

Average  mortality  among  Average  general  mortality       Excess  of  mortality 

Prisoners.  in  the  different  communities,     among  the  Prisoners, 

Old  System. 

1  in  27  =  3.70  per  cent.         1  in  42  =  2.38  per  cent.  1.32  per  cent. 

Auburn  System. 

1  in  35  =  2.86"      "  1  in  47  =  2.13    "     »  0.73    "      " 

Philadelphia  System. 

1  in  40  =  2.50   "      "  1  in  47  =  2.13    "     "  0.37    "       " 

The  third  table  exhibits  the  deaths  from  consumption  occurrinjr  in  seven  peni- 
tentiaries, in  the  first  five  the  Auburn  system  being  adopted,  and  in  the  last  two 
the  Pennsylvania  system. 

Auburn,  1826  to  1837, 12  years,  among  146  deaths  60  or  41  per  cent,  were  from  consumption, 

Singsine,  1830  to  1837, 8     «  "       ""^      "       "" 

Baltimore,  1831  to  1834,  4  « 
Boston,  1818  to  1835, 18  " 
Geneva,  1825  to  1837, 13  " 
Cherryhill,1829tol839,ll  « 
Pittsburgh,  1828  to  1834,  5  " 


The  remarks  of  the  author  upon  the  facts  exhibited  by  this  table  are  replete 
with  good  sense;  the  conclusions  derived  from  them  would,  however,  have  been 
more  exact  had  the  ratio  of  deaths  from  consumption  in  New  York,  Baltimore, 
Boston,  Geneva,  Philadelphia  and  Pittsburgh  been  compared  with  the  ratio  of 
deaths  from  the  same  disease  occurring  among  the  prisoners  in  the  respective 
penitentiaries  of  those  cities. 

The  facts  which  have  an  immediate  reference  to  the  effects  of  solitary  con- 
finement upon  the  mental  sanity  of  the  prisoners  subjected  to  it,  are  clearly  and 
fairly  stated  by  Dr.  Hoist,  and  compared  and  analyzed  with  a  good  deal  of  care. 
We  regret  that  the  impossibility  of  condensing  this  interesting  portion  of  his 
inquiry,  so  as  to  bring  it  within  our  limits  prevents  us  from  laying  it  before  our 
readers.  The  conclusion  at  which  the  author  arrives,  after  a  full  and  candid 
examination  of  the  subject  is,  that  solitary  confinement,  if  it  be  not  less,  is  not, 
certainly,  more  liable  to  the  charge  of  inducing  insanity  or  fatuity,  than  the  old 
systems  in  which  the  free  association  and  intercourse  of  the  prisoners  is  per- 
mitted. 

It  may  not  be  uninteresting  to  our  readers  to  state,  in  conclusion,  that  the 
authorities  from  which  Dr.  H.  has  derived  the  leading  materials  for  his  investi- 
gation are: — The  Annual  Reports  of  the  Board  of  Managers  of  the  Prison  Dis- 
cipline Society,  Boston.  The  Annual  Reports  of  the  Inspectors  of  the  Eastern 
State  Penitentiary  of  Pennsylvania,  Philadelphia.  The  Reports  of  the  Inspect- 
ors to  visit  the  diff'erent  Prisons  of  Great  Britain,  London.  Demetz  and  Blouet; 
Rapports  sur  les  Penitenciers  des  Etats  Unis,  Paris,  1837.  Ducpetiaux;  Des 
Progres  et  de  I'etat  Actuel  de  la  Referme  Penitentiaire,  Bruxelles,  1838.  Julius; 
Nordamerikas  Sittliche  Zustsinde,  Leipzig,  1839;  Journal  des  Debats,  1  Juni, 
1840.  De  la  Mortalite  et  De  la  folie  dans  le  Regime  Penitentiaire,  Annals 
d'Hygiene,  July,  1839.  Revue  Medicale  Francaise  et  etrangere,  Feb.  1839. 
Archives  Generales  de  Medecine,  Feb.  1839.  D.  F.  C. 


Art.  XXY.—The  Eighteenth  Jlnnual  Report  of  the  Officers  of  the  Retreat  for  the 
Insane  at  Hartford.     Hartford,  1842,  pp.  36. 

The  Connecticut  "Retreat  for  the  Insane"  at  Hartford,  has  long  enjoyed  a 
high  character  among  the  institutions  devoted  to  the  treatment  of  Insanity,  and 
we  are  pleased  to  learn  from  the  report  of  Dr.  Brigham,  its  able*  superintend- 
ent, that  its  prosperity  continues  undiminished. 

At  the  beginning  of  the  year  ending  March,  1842,  there  were  83  patients  in 


408  Bibliographical  Notices,  [Oct. 

the  house;  41  of  whom  were  males,  and  42  females.  During  the  year,  96  were 
admitted,  45  males  and  51  females;  89  were  discharged,  45  males  and  44 
females,  leaving  90  patients  under  care  at  the  end  of  the  year,  of  whom  41  were 
males  and  49  females.  Of  the  89  discharges,  56  were  "recovered,"  16  "im- 
proved," 9  "  unimproved,"  and  8  died.  Of  those  discharged,  all  with  four 
exceptions  were  recent  cases,  understanding  by  that  term,  those  of  less  than  one 
year's  duration,  and  also  including  cases  of  relapse  after  a  period  of  restoration. 

An  impression  prevails  with  many  persons  that  those  who  have  once  been 
insane,  rarely  have  their  mental  powers  fully  restored.  On  this  point  Dr.  Brigham 
speaks  very  decidedly.  "  From  our  own  observation,"  he  remarks,  "  and  exten- 
sive and  careful  inquiry  respecting  those  who  have  heretofore  been  discharged 
from  this  institution  as  recovered,  we  know  the  contrary  is  the  fact.  Many  who 
have  been  here  as  patients,  are  now  among  the  most  industrious  and  intelligent 
persons  in  the  community,  and  some  of  them  filling  stations  of  high  responsi- 
bility, as  parents,  teachers,  clergymen,  lawyers,  physicians,  merchants,  &c., 
and  discharging  their  duties  with  propriety  and  ability." 

We  have  on  a  few  occasions  had  assurances  from  the  friends  of  patients,  that 
after  recovery  from  an  attack  of  insanity,  their  minds  have  appeared  stronger 
and  more  active  than  at  any  previous  period  of  their  lives;  and  the  experience 
of  Dr.  B.  would  go  to  confirm  the  truth  of  these  assertions.  "  Some  few"  (of 
the  discharges)  he  observes,  "  I  am  happy  to  say,  exhibit  more  mental  vigour 
and  ability  than  previous  to  the  attack  of  insanity.  Of  this  I  feel  confident,  from 
my  own  observation  and  the  declaration  of  their  friends,  and  of  the  individuals 
themselves;"  and  this  result  he  believes  is  to  be  explained  on  physiological 
principles — "  the  unusual  and  long  continued  excitement  of  the  brain,  having 
permanently  increased  its  power  and  activity." 

Several  pages  of  the  report  before  us,  are  devoted  to  the  inculcation  of  correct 
views  of  the  nature  of  insanity,  the  importance  of  detecting  its  first  symptoms, 
and  of  subjecting  the  patient  promptly  to  a  judicious  course  of  treatment.  The 
value  of  this  kind  of  information  is  not  likely  to  be  overrated.  When  proper 
views  on  this  subject  prevail  in  a  community,  much  of  the  terror  of  the  dis- 
ease is  taken  from  it,  and  the  success  of  treatment  vastly  increased.  "  Who- 
ever," says  Sir  James  Mcintosh,  "  has  brought  himself  to  consider  a  disease 
of  the  brain,  as  differing  only  in  degree  from  a  disease  of  the  lungs,  has  robbed 
it  of  that  mysterious  horror,  which  forms  its  chief  malignity." 

The  neglect  of  proper  attention  to  the  physical  education  of  children,  and  the 
too  common  practice  of  forcing  the  mind  at  the  expense  of  the  body;  particu- 
larly in  those  whose  constitutions  are  least  calculated  for  such  a  system  of 
instruction,  we  fear,  will  for  some  time  to  come,  compel  those  who  have  charge 
of  institutions  for  the  insane,  to  state,  as  Dr.  Brigham  does  in  the  report  before 
us,  that  "  there  have  been  several  admissions  of  young  ladies  direct  from  board- 
ing schools,  and  of  young  men  from  colleges,  where  they  have  studied  exces- 
sively." 

The  proportion  of  suicidal  patients  appears  to  have  been  unusually  large;  no 
less  than  eleven  of  the  fifty-six  discharged,  as  recovered,  having  had  this  pro- 
pensity, and  these,  the  Dr.  considers  among  the  most  perfect  recoveries  he  has 
ever  witnessed. 

The  several  statistical  tables  at  the  end  of  the  report  are  of  interest  to  the 
profession;  and  we  give  below  an  abstract  of  nearly  all  of  them.  From  these, 
Ave  learn,  that  since  the  opening  of  the  Retreat  in  1824,  1164  patients  have  been 
admitted,  and  of  these,  657  have  been  cured,  and  77  have  died;  a  degree  of  suc- 
cess, which  it  can  hardly  be  hoped  to  surpass,  unless  where  very  marked  re- 
strictions exist  as  to  the  class  of  patients  admitted,  or  where  strict  regulations 
are  adopted  to  prevent  the  removal  of  any,  before  a  fair  trial  of  remedies  has 
been  made.  Without  a  full  statement  of  these  regulations  in  the  different  institu- 
tions, statistical  tables  of  this  kind  are  of  little  value.  By  neglecting  to  make 
such  statemelit,  great  injustice  may  be  done  by  those  who  are  comparing  the 
results  of  treatment  in  different  establishments. 

We  are  pleased  to  find  that  Dr.  B.  has  not  divided  his  cases  into  a  variety  of 


1842.]  Report  of  Hartford  Retreat,  409 

classes,  and  stated  the  percentage  of  cures  upon  each;  such  a  division  must 
necessarily  be  arbitrary  to  a  great  extent,  and  we  believe  has  already  been  pro- 
ductive of  bad  effects;  the  percentage  of  the  most  favourable  class,  being  gene- 
rally quoted  as  the  result  of  treatment  in  particular  institutions,  and  leading  to 
expectations  that  cannot  be  realized. 

The  probable  causes  of  insanity,  in  1 164  cases,  are  stated  to  be: — Hereditary  206. 
Ill-health  136.  Religious  anxiety  101.  Intemperance  91.  Intense  mental  exer- 
tion 93.  Domestic  troubles  58.  Loss  of  friends  59.  Puerperal  42.  Disap- 
pointed Affections  24.  Masturbation  20.  Exposure  and  fatigue  15.  Epilepsy 
12.  Repelled  cutaneous  disease  10.  Disappointed  ambition  8.  Injury  to  the 
head  9.  Disease  of  the  brain  11.  Jealousy  6.  Malformation  of  the  brain  3. 
Change  of  habits  4.  Apoplexy  2.  Paralysis  2.  Fright  3.  Bodily  injury  3. 
Exposure  to  fumes  of  charcoal  1.     Uncertain  246. 

Rapidity  of  the  Pulse  in  the  insane. — "In  176  patients  examined,  the  pulse 
of  all  but  8,  was  above  70  beats  in  a  minute,  as  follows:  from  60  to  70  in  8. 
From  70  to  80,  45.  From  80  to  90,  53.  From  90  to  100,  44.  From  100  to 
110,  12.  From  110  to  120,  14.  In  40  sane  individuals,  labourers  in  good 
health  and  at  rest,  the  pulse  was  found  to  range  from  70  to  80  beats  in  a  minute, 
which  may  be  considered  the  natural  healthy  pulse."  From  Dr.  Brigham's 
experiments,  he  concludes  "  that  the  pulse  of  the  insane,  whether  the  disease 
be  acute  or  chronic,  is  usually  more  rapid  than  in  the  sane."  Dr.  Earle,  whose 
paper  will  be  found  in  a  previous  number  of  this  journal,  arrives  at  the  same 
conclusion. 

Size  and  shape  of  the  head. — After  having  "  carefully  measured  the  heads  of 
116  insane  persons,  61  men  and  55  women,  and  also  the  heads  of  20  sane  men 
and  20  sane  woman;"  the  Doctor  believes  that  a  large  majority  of  his  patients 
have  good  sized  and  well-shaped  heads,  and  that  the  size  of  the  head  in  the 
insane,  corresponds  with  that  usually  found  among  sane  persons. 

Most  of  the  patients  "  have  all  their  senses  in  perfection;  a  few  have  hallu- 
cinations of  hearing  and  seeing,  and  a  few  have  their  taste  and  feeling  impaired. 
Two  have  remarkable  powers  of  vision.  They  read  with  equal  ease  and  great 
rapidity  print  reversed,  (a  book  held  with  the  top  downwards,)  and  in  the  usual 
way."  One  of  them  is  nearly  idiotic,  the  other,  an  intelligent  lady,  states, 
that  she  had  not  this  power  till  after  she  became  insane. 

Temperature  of  the  body. — Dr.  B.  has  found  cold  extremities  very  common 
*'  and  in  all  acute  cases,  and  in  many  of  the  chronic  cases  also,  the  head  is 
warmer  than  natural." 

On  this  point,  our  own  observations  have  led  to  a  less  general  conclusion. 
We  have  frequently  met  with  acute  cases,  even  of  the  most  violent  character, 
without  any  increase  in  the  heat  of  the  head,  and  often  with  that  part  at  a  lower 
temperature  than  was  found  in  the  sane  persons  about  them. 

Dr.  B.  has  found  the  temperature  of  different  parts  of  the  head  to  vary, 
judging  by  the  hand,  and  in  some  it  has  been  indicated  by  the  thermometer. 

The  secretions. — Dr.  B.'s  experiments  on  this  subject  go  to  prove  that  the 
insane  perspire  much  less  than  the  sane,  while  their  secretion  of  urine  is  more 
abundant; — partly,  no  doubt,  to  be  attributed  to  the  fact,  that  they  drink  as  well 
as  eat  more  than  sane  persons.  In  recent  cases  the  secretion  of  bile  has  been 
found  deficient  and  the  bowels  costive,  but  in  cases  of  long  standing,  there  is  an 
abundance  of  bile,  and  no  irregularity  of  the  bowels. 

Treatment. — A  portion  of  the  appendix  is  appropriated  to  the  medical  treatment 
"which  has  been  pursued  at  the  Retreat.  Starting  with  the  axiom  that  there  is 
no  specific  remedy  for  insanity.  Dr.  B.  goes  on  to  say,  that  in  his  experience, 
"recent  cases  for  the  most  part  require  a  mild  antiphlogistic  course;  but  regard 
should  be  had  to  the  cause  of  the  insanity.  If  occasioned  by  a  blow  or  other 
direct  physical  injury  of  the  head,  or  from  some  sudden  and  violent  mental  com- 
motion while  in  good  health,  free  depletion  by  bleeding  and  active  cathartics 
are  useful,  and  often  indispensable."  We  believe  that  most  of  those  who  have 
charge  of  the  insane  in  this  country,  will  agree  with  Dr.  B.  that  general  bleeding 
No.  VIIL— October,  1842.  35 


410  jBiblio graphical  Notices.  [Oct, 

is  rarely  required  in  the  cases  that  are  received  into  the  hospitals.  The  number 
is  reall}'^  very  small  where  such  treatment  is  necessary  at  all,  and  we  feel  sure 
that  the  injury,  marked,  and  sometimes  irreparable,  that  has  been  done  by  copi- 
ous venesection  before  the  patient  has  been  sent  from  home,  has  been  in  nearly 
every  institution,  a  source  of  regret  to  those  to  whom  the  subsequent  treatment 
has  been  entrusted. 

Purging,  pouring  cold  water  from  a  height  upon  the  head,  warm  pediluvia, 
the  warm  bath  with  cold  to  the  head,  the  cold  and  shower  bath  are  all  used 
under  certain  circumstances.  The  following  is  the  formula  for  a  favourite  com- 
bination extensively  used  at  the  Retreat,  and,  as  believed,  with  decided  advan- 
tage. "  Be. — Extract  of  conium,  .^vj.;  ferri  carb.  precip.  ^xij.;  molasses,  wine, 
water  (warm)  aa  qts.  ij.;  ol.  gaultheria,  or  ol.  sassafras,  gij.,  dissolved  in  alco- 
hol 5viij. — M."     Usual  dose  half  an  ounce  three  times  a  day. 

The  following  has  been  found  beneficial  "  in  many  nervous,  sleepless  and  hys- 
terical cases.  B:- — Tinct.  lupulin;  tinct.  hyoscyam.  aa  ^iv.;  gum  camphor,  5j.; 
ol.  valerian  Tl|xxxij. — M.  Dose,  one  to  two  drachms." 

"  Blisters,  issues,  and  particularly  setons  in  the  neck,  we  have  often  tried, 
but  rarely  witnessed  any  benefit  from  them."  The  opiate  treatment,  as  it  has 
been  called,  has  been  so  long  and  so  extensively  employed  at  Hartford,  that  we 
copy  the  remarks  of  Dr.  Brigham  as  possessing  value  on  this  point.  "  Opium 
has  always  been  used  at  this  institution  in  the  treatment  of  insanity,  and  often 
with  great  success.  In  some  cases  it  appears  to  be  useless,  and  in  a  few,  inju- 
rious, particularly  in  those  in  which  the  skin  is  dry  and  hot,  and  the  pulse  full 
and  hard.  But  such  cases  are  rare.  I  do  not,  however,  think  it  a  remedy  that 
of  itself  often  cures  this  disease,  but  it  is  a  valuable  adjuvant  to  others,  and 
secures  a  beneficial  degree  of  calmness  that  cannot  be  obtained  without  it.  We 
prefer  a  solution  of  sulphate  of  morphine  and  Dover's  powder  to  any  other  pre- 
parations of  opium."  The  doses  usually  employed  are  not  mentioned  in  the 
report. 

An  invigorating  diet  and  tonic  remedies  are  prescribed  in  many  cases.  "The 
various  preparations  of  bark,  quinine  and  other  tonic  remedies  are  used,  but  no 
one  preparation  is  so  generally  prescribed  as  the  combination  of  conium  and  iron 
above-mentioned,  and  from  none  have  we  seemed  to  derive  so  much  benefit." 

The  report  of  Mr.  Gallaudet,  the  excellent  and  devoted  chaplain  of  the  Re- 
treat, closes  the  appendix  before  us.  To  the  value  of  his  services  ample  testi- 
mony is  borne  by  the  superintendent.  The  whole  report  gives  evidence  of  the 
zeal  and  industry  of  Dr.  Brigham,  and  we  have  no  doubt,  will  be  the  medium  of 
conveying  correct  information  not  only  to  non-professional  readers,  but  to  many 
in  the  profession  who  have  had  few  opportunities  of  seeing  cases  of  insanity,  or 
of  directing  their  treatment.  T.  S.  K. 


Art.  XXVI. — Quarterly  Summary  of  the  Transactions  of  the  College  of  Physicians 
of  Philadelphia^  May,  June,  and  July,  1842,  pp.  24,  8vo. 

The  subject  of  most  interest  brought  before  the  College  during  the  past  quar- 
ter, was  that  of  Puerperal  Fever;  and  as  some  facts  of  great  importance  were 
adduced,  we  shall  give  the  report  of  the  proceedings  in  full. 

Dr.  Condie  begged  leave,  as  there  appeared  to  be  no  other  written  communi- 
cations to  be  presented,  to  call  the  attention  of  the  College  to  a  subject  of  very 
great  interest  to  the  medical  profession,  especially  to  those  of  its  members  en- 
gaged in  obstetrical  practice.  He  alluded,  he  remarked,  to  the  prevalence,  at 
the  present  time,  of  puerperal  fever  of  a  peculiarly  insidious  and  malignant  cha- 
racter. So  far  as  his  own  observations  and  those  of  his  medical  associates  with 
whom  he  had  conversed  on  the  subject,  extended,  nearly  every  case  of  the  dis- 
ease that  had  occurred  up  to  this  date,  had  terminated  fatally.  Dr.  C.  was  unable 
to  state  positively  the  exact  extent  of  the  fever,  either  in  regard  to  the  number  of 
parturient  females  who  have  been  attacked  by  it,  or  the  limits  within  which  it 


i 


1842.]         Trans,  of  College  of  Physicians  of  Philadelphia,  411 

had  as  yet  been  confined.  The  remarks  he  was  about  to  offer,  were  founded  upon 
cases  that  had  occurred  in  the  southern  sections  of  the  city,  and  neighbouring 
districts.  In  the  practice  of  one  gentleman,  extensively  engaged  as  an  obstetri- 
cian, nearly  every  female  he  has  attended  in  confinement,  during  several  weeks 
past,  within  the  above  limits,  had  been  attacked  by  the  fever.  It  is  also  known 
that  the  disease  has  occurred  in  the  lying-in  wards  of  the  Philadelphia  Hospital, 
at  Blockley,  and  the  Doctor  has  heard  of  several  cases  that  have  occurred  in  the 
northern  and  western  portions  of  the  county. 

So  far  as  the  observations  of  Dr.  C.  extend,  the  disease  has  been  found  to 
occur  alike  in  the  young  and  middle-aged— the  robust  and  delicate— in  those 
surrounded  by  every  comfort  and  afforded  every  attention  demanded  by  their  situ- 
ation, as  in  the  poor  and  destitute — as  well  in  those  who  were  confined  for  the 
first  time,  as  in  those  who  had  already  borne  a  number  of  children — and  as  well 
after  the  most  rapid  and  easy  labours,  as  after  those  that  were  protracted  and 
difficult. 

,  Usually,  within  the  first  three  days,  but  sometimes  within  a  few  hours,  after 
delivery,  the  patient  was  seized  with  a  chill,  differing  in  intensity  in  different 
cases — being  sometimes  so  slight  as  scarcely  to  attract  attention,  while  at  other 
times  it  amounted  to  a  perfect  rigor.  The  chill  was  quickly  succeeded  by  a  fe- 
brile reaction,  attended  with  a  hot,  dry  skin,  some  thirst,  a  white  milky  fur  upon 
the  tongue,  and  a  quick,  rapid  pulse,  amounting  in  some  cases  to  160  or  170  and 
upwards  in  a  minute.  The  pulse  was  often  full,  but  invariably  soft  and  com- 
pressible. There  was,  from  the  very  onset  of  the  disease,  a  peculiar  anxious  or 
distressed  expression  of  the  countenance — and  a  mottled  or  irregular  flushed 
appearance  of  the  face.  The  patient  soon  after  the  attack,  generally  complained 
of  some  soreness  or  dull  pain — often  confined,  at  first,  to  the  groins  or  across  the 
hypogastric  region.  The  pain  was  increased  upon  pressure.  It  very  speedily 
increased  in  intensity,  and  spread  over  the  whole  of  the  abdomen,  which  now 
became  tumid  and  more  or  less  tympanitic. 

In  many  cases,  the  pain  of  the  abdomen  was  described  by  the  patient  rather 
as  a  sense  of  soreness  than  of  acute  pain,  and  although  augmented  upon  the 
slightest  pressure  being  applied,  the  increased  suffering  was  indicated  more  by 
the  expression  of  the  patient's  countenance  than  by  acute  cries.  Occasionally, 
the  Doctor  found  that  when  the  pressure  was  steadily  continued,  and  gradually 
increased,  the  pain  would  appear  to  be  rather  lessened  than  augmented.  The 
bowels  were  usually  constipated,  but  in  all  the  cases  which  fell  under  the  obser- 
vation of  Dr.  C,  they  were  easily  acted  upon — the  exhibition  of  an  ordinary 
dose  of  any  mild  cathartic,  causing  full  and  repeated  evacuations,  differing  in 
appearance,  being  either  ordinary  feces,  or  a  dark-coloured,  very  offensive  fluid 
— followed,  more  or  less  speedily,  by  the  frequent  discharge,  with  considerable 
tenesmus,  of  small  portions  of  a  slightly  discoloured  mucus.  In  one  case,  in 
which  the  discharges  from  the  bowels  were  very  frequent  during  the  entire  con- 
tinuance of  the  disease,  they  consisted  entirely  of  small  quantities  of  a  transpa- 
rent gelatiniform  fluid. 

From  the  first  onset  of  the  disease  the  stomach  was,  in  nearly  every  case,  ex- 
tremely irritable — rejecting  soon  after  they  were  swallowed,  the  drinks  and  other 
articles  taken  by  the  patient.  Occasionally,  the  frequent  ejection,  by  vomiting, 
of  a  greenish  flocculent  fluid,  occurred  at  an  early  period  of  the  disease. 

Very  generally,  so  soon  as  the  disease  became  fully  developed,  the  secretion 
of  milk,  as  well  as  the  lochial  discharge,  ceased,  or  became  greatly  diminished — 
occasionally,  however,  the  milk  was  secreted  very  freely  until  within  a  few 
hours  before  death,  and  the  only  change  observed  in  the  condition  of  the  lochia, 
was  in  its  becoming  much  darker,  and  exhaling  a  disagreeable,  but  not  decided- 
ly foetid  odour. 

Soon  after  the  occurrence  of  the  abdominal  pain  and  tumefaction,  the  respira- 
tion of  the  patient  became  short  and  oppressed,  and  attended  with  an  intolerable 
sense  of  weight  and  uneasiness  at  the  praecordia.  Some  of  the  patients  referred 
all  of  their  sufferings,  in  the  advanced  stage  of  the  disease,  to  tliis  peculiar  and 
distressing  sensation;  declaring  that  if  only  this  could,  by  any  means,  be  re- 


412  JBiblio graphical  Notices,     -««.•:  [^Oct 

moved,  they  would  be  well.  The  oppression  and  difficulty  of  respiration  was 
not  always  found  to  be  in  direct  proportion  to  the  emphysematous  distension  of 
the  abdomen. 

As  the  disease  progressed,  the  abdomen  became,  in  general,  more  swollen, 
tense,  and  painful;  the  shortness  of  respiration  more  striking,  and  the  pulse  more 
frequent,  quick  and  feeble — the  countenance  of  the  patient  assuming  a  very 
peculiar,  dusky  hue,  and  dejected  expression.  The  irritability  of  the  stomach 
increased — vomiting  became  frequent — and,  very  commonly,  there  speedily  en- 
sued a  discharge  from  the  stomach,  at  short  intervals,  by  a  species  of  eructation, 
of  mouthfuls  of  a  dark  greenish  or  chocolate  coloured,  flocculent  fluid,  which, 
according  to  Dr.  C.'s  observation,  was  invariably  a  fatal  symptom;  it  being  very 
soon  succeeded  by  a  cold,  clammy  condition  of  the  skin,  occurring  first  in  the 
extremities — a  dark  leaden  hue  and  haggard  expression  of  the  countenance — a 
sunken  state  of  the  eyes— profuse  perspiration,  especially  about  the  head,  face, 
and  superior  extremities — and  death.  In  one  or  two  cases,  death  was  preceded 
by  violent  delirium — an  injected  state  of  the  eyes — flushing  of  the  cheeks — con- 
vulsive movements  of  the  limbs,  and  other  symptoms  of  encephalic  inflamma- 
tion; but,  in  the  majority  of  instances,  the  mental  powers  of  the  patient  were 
but  little  affected  throughout  the  disease;  death  appearing  to  result  from  com- 
plete exhaustion  of  the  vital  powers,  and  occurred  without  a  struggle. 

In  some  of  the  cases,  a  short  time  previous  to  death,  there  occurred  so  com- 
plete a  remission  of  all  the  distinguishing  symptoms  of  the  disease,  as  to  induce 
the  belief,  even  in  the  medical  attendants,  that  the  patient  was  about  to  recover. 
This  remission  was,  however,  in  all  the  instances  which  have  fallen  under  the 
notice  of  Dr.  C,  speedily  followed  by  collapse  and  death.  In  one  striking  in- 
stance, seen  by  the  Doctor,  in  consultation  with  Drs.  Hewson  and  Hodge,  the 
patient,  on  the  fourth  day  after  what  was  considered  a  very  severe  attack,  was 
found  sitting  up  in  bed,  free  from  fever,  pain,  and  difficulty  of  breathing,  nursing 
her  child;  on  being  questioned,  she  declared  that  she  felt  perfectly  well,  though 
weak — the  next  evening  she  was  a  corpse. 

Death  generally  occurred  upon  the  third  or  fourth  day  of  the  disease — in  but 
few  cases  was  the  disease  protracted  beyond  the  fifth  day. 

The  Doctor  remarked,  that  it  was  a  fact  worthy  of  notice — though  he  was  not 
aware  it  would  throw  much  light  upon  the  causes  and  pathological  character  of 
the  disease — that  in  the  neighbourhoods  and  even  houses  in  which  cases  of 
puerperal  fever  have  occurred,  erysipelas  has  prevailed  to  a  greater  or  less  ex- 
tent. Erysipelas,  has  indeed  been  far  more  prevalent  throughout  the  whole  of 
the  districts  south  of  the  city,  during  the  past  winter  and  spring,  than  Dr.  C. 
has  known  it  to  be  during  the  last  twenty-six  years. 

An  important  query  presents  itself,  the  Doctor  observed,  in  reference  to  the  par- 
ticular form  of  puerperal  fever  now  prevalent.  Is  it,  namely,  capable  of  being 
propagated  by  contagion,  and  is  a  physician  who  has  been  in  attendance  upon  a 
case  of  the  disease,  warranted  in  continuing,  without  interruption,  his  practice 
as  an  obstetrician]  Dr.  C,  although  not  a  believer  in  the  contagious  character 
of  many  of  those  aff"ections  generally  supposed  to  be  propagated  in  this  man- 
ner, has  nevertheless  become  convinced  by  the  facts  that  have  fallen  under  his 
notice,  that  the  puerperal  fever  now  prevailing,  is  capable  of  being  communi- 
cated by  contagion.  How  otherwise  can  be  explained,  the  very  curious  circum- 
stance of  the  disease,  in  one  district,  being  exclusively  confined  to  the  practice 
of  a  single  physician,  a  Fellow  of  this  College,  extensively  engaged  in  obstet- 
rical practice — while  no  instance  of  the  disease  has  occurred  in  the  patients  under 
the  care  of  any  other  accoucheur  practising  within  the  same  district;  scarcely  a 
female  that  has  been  delivered  by  this  gentleman  for  weeks  past  has  escaped 
an  attack]  Wishing  to  confine  his  remarks  on  the  present  occasion  entirely  to 
the  facts  that  have  fallen  under  his  own  observation  since  the  occurrence  of  the 
disease  in  this  vicinity,  Dr.  C.  declined  referring  to  the  numerous  facts  upon 
record,  in  proof  of  the  contagiousness  of  puerperal  fever. 

The  cases  of  the  disease  that  have  fallen  under  the  notice  of  Dr.  C,  have 
been  very  variously  treated;  in  the  majority  of  them,  the  eff'ects  of  venesection 


% 


1842.]         Trans,  of  College  of  Physicians  of  Philadelphia.  413 

in  the  first  stage,  followed  by  active  purgation,  have  been  very  fully  tried,  fol- 
lowed by  fomentation  and  blisters  to  the  abdomen,  and  Dover's  powder,  the 
nitrous  powders  with  calomel,  pills  of  blue  mass,  opium  and  ipecacuanha,  spirits 
of  turpentine,  &c.,  internally.  Under  every  variety  of  treatment  the  disease 
has  appeared  to  run  pretty  much  the  same  fatal  course.  So  far  as  the  observa- 
tions of  Dr.  C.  extend,  the  disease  is  not  one  in  which  active  depletion,  but 
more  especially  by  the  lancet,  will  be  found  to  produce  any  good  effects: — in 
fact,  in  no  one  of  the  cases  in  which  he  has  been  consulted,  could  he  be  induced 
even  in  the  earliest  stages,  to  give  his  consent  to  the  detraction  of  blood  to  any 
extent — so  strongly  did  the  character  of  the  pulse,  and  all  the  symptoms  pre- 
sent contra-indicate  it.  In  one  instance  the  extensive  application  of  leeches 
over  the  abdomen,  appeared  to  him  to  cause  a  very  decided  abatement  of  the 
pain,  and  more  urgent  symptoms  of  the  disease;  but  from  the  rapidity  with 
which  the  patient  subsequently  sunk,  and  the  early  period  at  which  death  took 
place,  he  is  fearful  that  the  occurrence  of  the  fatal  collapse  was  accelerated  by 
the  leeching. 

In  the  cases  of  the  disease  which  have  occurred  in  the  Philadelphia  Hospital, 
Blockley,  the  effects  of  direct  depletion  have  been  very  fully  tried — in  every 
instance,  however,  in  which  venesection  has  been  resorted  to,  in  that  institution, 
if  Dr.  C.  is  correctly  informed,  the  disease  has  terminated  fatally. 

Blisters  to  the  abdomen  were  certainly  beneficial  in  every  instance,  by  the 
abatement  they  procured  of  the  pain  and  intumescence — applied  over  the  prae- 
cordia,  they  appeared,  in  some  instances,  to  relieve  very  decidedly  the  oppres- 
sion and  distress  caused  by  the  difficulty  of  respiration. 

In  one  case,  the  administration  of  small  doses  of  acetate  of  lead  in  solution, 
suggested  by  Dr.  Hewson,  very  speedily  abated  the  irritability  of  the  stomach, 
so  as  to  enable  it  to  retain  the  drinks  and  remedies  subsequently  administered, 
which  previously  had  been  almost  immediately  rejected. 

Dr.  Huston  inquired  of  Dr.  Condie,  whether  all  the  children  of  the  females 
who  had  died  of  the  disease  in  the  southern  districts,  were  living — and  if  not, 
whether  an  examination  had  been  made  after  their  death,  and  what  was  its 
result? 

Dr.  Condie  replied,  that  the  majority  of  the  children  were  still  living  and 
doing  well.  In  three  of  the  cases  attended  by  Dr.  Rutter,  who  had  seen  the 
greatest  amount  of  the  disease,  the  children  were  still-born;  two  being  in  an 
advanced  state  of  putrefaction;  in  two  other  instances  the  children  had  died  of 
erysipelas,  one  shortly  after  birth,  the  other  three  weeks  subsequently. 

Dr.  J.  R.  Paul  inquired  what  had  been  the  result  of  the  autopsies  in  the  cases 
that  had  fallen  under  the  observation  of  Dr.  CI 

Dr.  Condie  replied,  that  he  had  declined  availing  himself  of  the  very  few  op- 
portunities afforded  him  for  making  a  post  mortem  examination  of  those  who  had 
died  of  the  disease.  Being  somewhat  extensively  engaged  in  obstetrical  prac- 
tice, he  considered  it  a  matter  of  prudence  to  subject  himself  as  little  as  possi- 
ble to  contact  with  the  diseased  secretions,  poured  out  in  this  disease,  into  the 
cavities  of  the  abdomen,  or  of  the  uterus;  he  believed,  however,  that  his  friend, 
Dr.  Rutter,  who  was  present,  had  made  several  examinations  after  death  in 
cases  that  had  fallen  under  his  care,  the  result  of  which  he  would  no  doubt  state 
to  the  College. 

Dr.  Rutter  replied,  that  in  three  cases  of  the  disease  which  had  died  under  his 
care,  a  post  mortem  examination  had  been  made  by  Dr.  Ashmead,  to  whom  he 
would  refer  the  College  for  the  information  desired. 

Dr.  Ashmead  had  found  in  all  of  these  three  cases  nearly  the  same  lesions,  dif- 
fering only  in  degree.  In  the  first  case  examined  by  him,  there  was  general  peri- 
toneal inflammation,  with  slight  effusion  of  serum  with  flocculi  floating  in  it; 
serous  infiltration  into  the  cellular  tissue  of  the  broad  ligaments,  a  little  lymph  on 
the  surface  of  one  of  the  ovaries,  a  rose-coloured  blush  covering  the  peritoneum 
of  the  uterus  and  intestines,  no  adhesion  among  the  intestines,  and  great  tympa- 
nitis. The  uterus  being  laid  open  presented  a  perfectly  natural  appearance.  In 
the  second  case,  the  patient  had  died  on  the  sixth  day.    There  was  the  same 

35* 


A^i 


414  Bibliographical  Notices,  [Oct. 

appearance  of  peritoneal  inflammation,  but  in  a  higher  degree,  with  serous  effu- 
sion, and  slight  recent  adhesions  between  the  peritoneal  surfaces  of  the  intes- 
tines. Pus  was  found  in  the  cellular  tissue  of  the  broad  ligaments,  in  the 
structure  of  the  uterus,  and  Dr.  A.  believed,  also  in  the  cavity  of  the  veins — 
the  uterine  cavity  was  healthy.  This  patient  had  vomited  a  dark  or  coffee  co- 
lored substance,  a  quantity  of  which  was  found  in  the  stomach  after  death.  In 
the  third  case,  the  patient  had  died  on  the  third  day.  A  large  quantity  of  lymph 
was  found  effused  in  the  cavity  of  the  peritoneum,  with  a  copious  deposit  of 
pus  in  the  broad  ligaments.  Dr.  Ashmead  thought  that  the  veins  were  also  in- 
volved in  this  case,  but  Dr.  Hodge,  who  was  present  at  the  autopsy,  did  not 
consider  the  appearance  sufficiently  positive  to  substantiate  this  conclusion.  In 
this,  as  well  as  in  the  other  cases,  the  liver,  spleen,  and  kidneys  were  softened, 
as  is  seen  in  cases  of  low,  malignant  fevers.  In  one  of  the  cases,  the  stomach 
contained  a  fluid  resembling  coffee  grounds,  and  probably  the  same  as  the  black 
vomit  of  yellow  fever;  the  follicles  of  the  mucous  membrane  of  the  stomach, 
were  in  this  case  enlarged,  although  its  mucous  surface  was  nol  inflamed.  Dr. 
Ashmead  had  participated  in  the  treatment  of  several  cases.  In  one  case  the 
patient  really  seemed  to  have  improved,  and  there  appeared  to  be  a  fair  prospect 
of  recovery,  had  it  not  been  for  the  enormous  tympanitis,  which,  by  preventing 
the  free  action  of  the  lungs,  was,  in  the  opinion  of  Dr.  A.,  the  immediate  cause 
of  death  in  these  cases.  Efforts  v/ere  made  to  draw  off  the  gas  by  the  tube  and 
syringe,  but  without  success,  and  the  patient  died.  It  was  found  after  death, 
that  the  gas  occupied  the  small  intestines,  the  colon  being  nearly  empty,  which 
accounted  for  this  failure.  Dr.  Ashmead  had  seen  leeches  used  largely  in  one 
case,  with  great  relief,  and  with  an  apparent  improvement  in  the  pulse,  but  the 
patient  died.  He  had  also  tried  the  free  use  of  tartar  emetic,  with  no  better 
result.  He  had  not  certainly  the  same  fear  of  depletion  as  Dr.  Condie — not- 
withstanding the  unfavourable  result  of  the  cases  in  which  he  had  seen  it  re- 
sorted to. 

Dr.  Huston  wished  to  be  informed,  if  there  was  any  extraordinary  hemor- 
rhage in  the  labours  which  preceded  the  disease. 

Dr.  Condie  replied,  that  nothing  unusual  had  happened  in  the  course  of  the 
labours  in  the  cases  of  the  disease  which  had  fallen  under  his  notice;  the  lochial 
discharge  in  most  instances  was  rather  less  than  usual,  and  generally  of  a  darker 
and  more  grumous  appearance.  The  milk  was  secreted  abundantly  at  the  usual 
time,  and  the  patients  appeared  to  be,  in  every  other  respect,  doing  well,  until 
the  moment  of  attack. 

Dr.  C.  had  alluded  before  to  the  sense  of  oppression  complained  of  by  the 
patients,  and  to  the  shortness  and  difficulty  of  respiration.  He  did  not  believe 
with  Dr.  Ashmead,  that  this  was  owing  entirely  to  the  tympanitic  distension  of 
the  abdomen.  He  was  inclined  to  refer  it  rather  to  the  extension  of  the  inflam- 
mation over  the  surface  of  the  diaphragm.  It  was  not  always  in  proportion  to 
the  extent  of  the  tympanitis — and  was  generally  absent  so  long  as  the  pain  or 
soreness  was  confined  to  the  lower  portion  of  the  abdomen,  but  invariably  ensued 
so  soon  as  the  pain  had  extended  over  the  whole  abdomen — and  was  always 
attended  by  an  intolerable  and  indescribable  sense  of  distress  about  the  region 
of  the  praecordia.  The  diaphragm  appeared  to  the  Doctor  to  cease  to  act  when 
the  difficulty  of  breathing  was  at  its  height — respiration  being  carried  on  entirely 
by  the  intercostal  muscles. 

Dr.  Huston  rose  to  make  some  statements  in  reference  to  the  appearance  of 
this  alarming  disease  in  the  Philadelphia  Hospital,  with  which  institution  he 
was  connected  as  obstetrician.  About  two  weeks  since,  he  and  his  colleague, 
Dr.  Gillingham,  were  sent  for  on  account  of  the  occurrence  of  the  epidemic. 

Three  or  four  cases  had  died  under  the  treatment  of  the  house  pupils,  and 
three  cases  were  then  pending. 

These  had  been  largely  depleted,  and  had  taken  active  cathartics  and  enemata, 
without  producing  any  action  on  the  bowels,  which  appeared  in  all  of  them  to 
be  remarkably  torpid.     These  cases  also  died. 

One  woman  had  been  delivered  about  twenty-four  hours  previous  to  their  visit, 


^ 


1842.]        Trans,  of  College  of  Physicians  of  Philadelphia.  415 

and  had  just  been  seized  with  the  disease;  her  respiration  was  very  bad,  pulse 
rapid  and  compressible,  tongue  of  a  cream  colour,  (which  Dr.  H.  had  noticed 
in  all  the  cases,)  restlessness  extreme,  face  suffused,  being  red  and  blue  in  spots. 
These  symptoms  had  been  preceded  by  a  heavy  chill,  and  the  case  was  consi- 
dered a  very  severe  one,  in  its  incipient  stage.  Dr.  Huston  ventured  to  suggest 
a  change  in  the  practice,  especially  as  all  the  other  cases  had  died.  He  pro- 
posed a  full  dose  of  opium,  (2  grs.)  with  calomel,  sinapisms  to  the  feet,  carbo- 
nate of  ammonia  julap,  &c. — no  blood  was  abstracted  from  the  arm — and  under 
this  plan  the  patient  recovered. 

Dr.  Huston  was  informed  by  Dr.  Barron,  the  house  pupil,  that  all  the  children, 
born  of  the  women  who  had  died  of  this  epidemic,  had  died  of  peritoneal  in- 
flammation. The  lying-in  ward  has  since  been  cleared,  and  the  patients  removed 
to  other  parts  of  the  house.  Three  women  confined  during  the  prevalence  of 
the  epidemic,  escaped  the  disease.  One  of  these  was  a  cripple,  who  occupied 
a  bed  in  the  same  room  with  those  who  had  died.  Dr.  Huston  has  not  seen  the 
disease  in  private  practice. 

Dr.  H.  is  opposed  to  the  use  of  the  lancet  in  the  epidemic.  The  condition 
of  the  nervous  system  is  such  as  utterly  to  forbid  it.  It  is  from  the  first  broken 
down  by  the  poison  producing  the  disease,  and  all  the  symptoms  indicate  an 
opposite  course  of  treatment.  The  experience  of  this  city.  Dr.  H.  believes, 
does  not  justify  the  practice.  In  the  present  epidemic  it  has  certainly  failed, 
and  in  the  only  case  of  recovery  which  he  has  seen,  it  was  not  used.  This 
corresponds  with  his  observations  in  former  years.  Dr.  H.  has  tried  the  anti- 
monial  practice,  and  believes  it  may  answer  a  good  purpose  in  mild  sporadic 
cases,  but  not  in  these  malignant  cases.  The  epidemic  and  sporadic  cases  are 
altogether  different.  * 

Dr.  Huston  has  noticed  a  tendency  to  erysipelas,  lately,  and  has  seen  three 
cases  of  severe  illness  in  men,  bearing  an  analogy  to  the  disease  under  consider- 
ation. There  was  the  same  appearance  of  the  tongue  and  pulse,  the  same  vio- 
lent abdominal  pain,  as  in  this  epidemic.  One  of  these  patients  had  died — nei- 
ther of  them  would  bear  the  abstraction  of  bloodi 

Dr.  Condie  remarked,  that  from  the  description  given  by  Dr.  Huston  of  the 
epidemic  at  the  Alms  House,  he  should  think  it  a  somewhat  less  malignant  form 
of  the  disease  than  that  which  is  prevailing  in  the  southern  part  of  the  city.  The 
practice  adopted  by  Dr.  Huston,  with  calomel  and  opium,  &c.,  had  been  tried 
fairly  in  one  case,  in  which  he  was  in  attendance,  but  without  success.  Dr.  C, 
had  not  practised  venesection  in  any  case — the  state  of  the  pulse  and  of  the 
system  generally,  in  his  opinion,  forbid  it,  in  every  instance  which  he  had  seen. 
Drs.  Hewson,  Neill  and  Hodge,  with  whom  he  had  been  associated  in  consul- 
tation in  several  cases,  had  coincided  entirely  with  him  in  the  views  he  enter- 
tained as  to  the  inadmissibility  of  any  extensive  depletion. 

Dr.  Ashmead  remarked,  that  he  did  not  coincide  with  some  of  the  other  Fel- 
lows who  spoke  this  evening,  as  to  the  contagiousness  of  the  complaint.  He 
had  heard  of  the  appearance  of  the  disease  in  Lower  Dublin,  and  at  German- 
town,  but  it  was  by  no  means  general,  nor  did  it  invariably  follow  in  the  track 
of  any  physician. 

Dr.  Condie  replied,  that  there  was  a  great  difference  between  the  facility  with 
which  contagion  could  be  conveyed  by  a  practitioner  of  midwifery,  engaged  in 
a  large  city  practice,  attending  probably  three  or  four  cases  of  parturition  daily, 
and  within  a  very  few  hours  of  each  other — and  by  an  accoucheur  in  the  coun- 
try, whose  annual  practice  would,  perhaps,  fall  far  short  of  that  of  one  month 
of  the  former,  and  between  whose  cases,  consequently,  there  elapsed  often  days 
or  even  weeks — thus,  under  ordinary  circumstances,  rendering  it  very  difficult 
for  him  to  communicate  contagion  from  one  of  his  patients  to  another.  One  fact 
would  seem,  however,  to  establish  the  eminently  contagious  or  infectious  cha- 
racter of  the  more  virulent  cases  of  puerperal  fever,  and  which  is,  that  where  it 
occurs  as  an  epidemic  in  the  lying-in  wards  of  an  hospital,  no  other  means  have 
been  found  to  prevent  the  spread  of  the  disease  among  the  inmates  and  check  its 
further  occurrence,  except  that  of  dispersing  the  patients  and  abandoning  the 


416  Bibliographical  Notices,  [Oct. 

wards.  It  has  even  happened  that  after  the  wards  have  been  fully  cleansed  and 
ventilated,  and  remained  vacant  for  some  time,  on  their  re-occupation  the  disease 
has  broken  out  anew. 

Dr.  Rutter  obsei-ved,  that  after  the  occurrence  of  a  number  of  cases  of  the 
disease  in  his  practice,  he  had  left  the  city  and  remained  absent  for  a  week,  but 
on  returning,  no  article  of  clothing  he  then  wore  having  been  used  by  him  be- 
fore, one  of  the  very  first  cases  of  parturition  he  attended  was  followed  by  an 
attack  of  the  fever,  and  terminated  fatally — he  cannot  readily,  therefore,  believe 
in  the  transmission  of  the  disease  from  female  to  female,  by  a  contagion  conveyed 
in  the  person  or  clothes  of  the  physician. 

Dr.  Warrington  remarked,  that  although  he  had  recently  seen  several  cases  of 
severe  puerperal  peritonitis,  and  metritis,  he  doubted  whether  these  partook  of 
the  character  of  the  disease  that  had  been  described  by  Dr.  Condie,  as  having 
been  so  fatal  in  the  southern  part  of  the  city.  In  reference  to  the  idea  of  the 
contagiousness  of  this  disease,  and  of  its  relation  to  erysipelas,  he  would  state 
facts  as  they  had  occurred  under  his  observation,  but  would  advance  no  opinion. 
The  first  case  of  the  disease.  Dr.  W.  saw  in  the  commencement  of  the  first 
month  of  the  present  year,  in  consultation  with  Drs.  H.  S.  Patterson  and  Per- 
rine.  This  occurred  after  a  severe  labour,  in  which  instruments  were  used,  and 
which  was  attended  with  alarming  hemorrhage.  The  patient  was  attacked  with 
rigor  on  the  third  day  after  delivery,  followed  by  the  symptoms  of  peritonitis. 
She  died  on  the  fifth  day. 

There  was  great  tympanitis,  and  on  examination  after  death,  a  large  quantity 
of  flocculent  lymph  and  pus,  mixed  with  a  serous  fluid,  were  found  effused  in 
the  abdominal  cavity,  which  the  Doctor  laded  out  with  his  hands.  In  the  right 
pleura  there  existed  adhesions,  both  chronic  and  recent.  A  few  days  after  this, 
Dr.  W.  was  called  upon  to  deliver  three  women  in  rapid  succession.  One  of 
these  was  attacked  soon  after  her  labour,  with  metritis;  and  another  had  inflam- 
mation of  the  peritoneum  covering  the  uterus;  both  were  very  ill,  but  recovered 
under  free  depletion.  In  the  third  case,  the  labour  was  very  severe  and  pro- 
tracted, and  the  child  was  still-born.  The  patient  v;as  attacked  with  puerperal 
peritonitis,  was  bled  freely,  but  died  on  the  fifth  day  of  the  disease.  Soon 
after  these.  Dr.  Warrington  was  called  to  another  case,  in  Baker  street,  (west  of 
Broad  street,)  in  v^hich  there  had  been  great  hemorrhage,  and  a  portion  of  the 
placenta  was  retained  within  the  uterus.  This  patient  was  attacked  with  peri- 
tonitis in  a  severe  form  on  the  second  day;  the  pulse  was  quick  and  active,  and 
the  skin  hot;  she  was  bled  freely  with  decided  relief,  and  an  improvement  in  the 
pulse.  The  operation  was  repeated,  and  other  antiphlogistic  treatment  was  in- 
stituted. She  died  on  the  fifth  day.  Another  woman  delivered  on  the  same 
day,  was  similarly  attacked,  within  forty-eight  hours  after  confinement,  and  died 
on  the  fifth  day.     The  treatment  was  similar  in  the  two  cases. 

The  nurse  who  attended  upon  this  patient,  was  attacked  with  violent  erysipe- 
las of  the  face  and  scalp  a  few  days  after,  and  died.  The  system  being  so  pros- 
trated as  seemingly  to  forbid  the  lancet,  she  was  not  bled. 

In  three  of  the  fatal  cases,  autopsies  were  made,  at  which  Dr.  Warrington 
was  not  present,  from  a  fear  that  he  might  more  readily  communicate  the  dis- 
ease, if  he  participated  in  them.  The  appearances  were  represented  to  be  simi- 
lar to  those  stated  by  Dr.  Ashmead. 

After  these  cases,  about  the  beginning  of  the  second  month.  Dr.  Warrington 
was  summoned  to  a  female  who  had  been  delivered  by  one  of  his  pupils.  The 
symptoms  of  puerperal  fever  of  a  severe  form  were  just  commencing — pulse 
frequent.  Immediately,  twenty-four  ounces  of  blood  were  drawn,  which  caused 
fainting.  Relief  followed  the  bleeding,  which  was  repeated  at  intervals  of  seve- 
ral hours,  three  times,  until  seventy  ounces  in  all  had  been  taken  away.  A  large 
blister  was  then  applied  over  the  abdomen.  Tlie  patient  recovered.  The  nurse 
who  attended  upon  her  had  severe  erysipelas  of  the  leg,  from  which  she  reco- 
vered. 

Soon  after,  a  respectable  female  in  Front  street,  had  a  very  severe  labour, 
attended  with  profuse  hemorrhage,  and  gave  birth  to  a  putrid  child.     She  was 


1842.]         Trans,  of  College  of  Physicians  of  Philadelphia,  417 

attacked,  in  twenty-four  hours,  with  violent  pain  in  the  right  iliac  region,  chilli- 
ness, fever,  &c. — pulse  strong  and  frequent.  She  was  bled  about  sixty-five  ounces, 
in  thirteen  hours,  and  was  blistered  over  the  abdomen.     She  also  recovered. 

Dr.  Warrington's  experience  in  the  cases  which  had  fallen  under  his  notice, 
was  directly  in  favour  of  free  depletion.  He  had  not  seen  it  tried,  however,  in 
the  violent  and  malignant  form  of  the  disease  described  by  Dr.  Condie. 

Dr.  W.  stated  that  he  had  a  few  days  since  received  a  letter  from  a  medical 
friend  in  Doylestown,  Bucks  county,  informing  him  of  the  prevalence  of  puer- 
peral peritonitis  in  that  district  of  country,  with  the  promise  of  a  detailed  ac- 
count of  its  origin  and  progress  at  a  future  period. 

Dr.  West  stated,  that  some  facts,  in  proof  of  the  contagiousness  of  puerperal 
fever,  had  been  related  to  him  by  Dr.  Jackson,  of  this  city,  formerly  of  North- 
umberland, and  a  Fellow  of  this  College,  who  he  regretted  was  absent  this 
evening. 

Whilst  practising  in  Northumberland  county,  seven  females  delivered  by  Dr. 
Jackson  in  rapid  succession,  were  all  attacked  with  puerperal  fever.  The  first 
and  fourth  of  these  cases  were  freely  bled  and  purged,  and  recovered,  the  others 
terminated  fatally. 

"  Women,"  the  doctor  remarked,  "  who  had  expected  me  to  attend  upon  them, 
now  becoming  alarmed,  removed  out  of  my  reach,  and  others  sent  for  a  physi- 
cian residing  several  miles  distant.  These  women,  as  well  as  those  attended  by 
mid  wives,  all  did  well;  nor  did  we  hear  of  any  deaths  in  child-bed  within  a 
radius  of  fifty  miles,  excepting  two,  and  those  1  afterwards  ascertained  to  have 
been  caused  by  other  diseases.  I  now  began  to  be  seriously  alarmed  on  the 
score  of  contagion.  Although  I  had  used  some  personal  precautions  before,  I 
now  feared  that  they  had  not  been  sufficient. 

"To  the  next  case  of  parturition,  then,  I  did  not  go  without,  as  was  supposed, 
a  thorough  purification.  This  woman  was  attacked  with  the  disease  and  died. 
I  then  recollected  that  I  had  worn  to  her  house  the  same  gloves,  lined  with  flan- 
nel, which  I  had  worn  through  all  my  previous  attendance.  I  do  not  pretend  to 
say  that  this  was  the  source  of  the  contagion  in  this  case.   I  merely  state  the  fact. 

"  During  the  next  two  months,  I  attended  several  obstetrical  patients,  who  all 
did  well;  and  then  I  was  again  horrified  with  a  decisive  and  violent  case  of  the 
fever.  The  patient  recovered  under  the  most  vigorous  depletion  by  bleeding, 
puking,  sweating,  and  purging.  A  ninth  case  soon  after  occurred,  and  was 
cured  by  the  same  means. 

"  No  contagion,  it  is  certain,  could  have  reached  these  last  two  cases,  unless 
through  the  medium  of  injection  pipes  and  bladders,  which  had  been  used  by 
them  a  day  or  two  after  delivery,  and  which  1  found  were  the  very  instruments 
that  had  been  used  in  two  of  my  former  cases,  and  then  put  away,  probably 
without  any  purification. 

*•  It  may  be  worthy  of  remark,  that  the  house  in  which  the  first  case  of  the 
disease  occurred,  was  filthy  almost  beyond  comparison;  add  to  which,  I  was 
attending  and  dressing  a  limb  extensively  mortified  from  erysipelas,  and  went 
immediately  to  the  accouchement  with  my  clothes  and  the  unfortunate  gloves 
most  thoroughly  imbued  with  the  effluvia  of  that  sphacelation.  The  erysipelas 
had  been  very  prevalent  for  six  months  and  difficult  to  manage. 

"  Never  before  nor  since  that  time,  have  I  seen  anything  similar  to  this  dis- 
ease— nothing  similar  even  to  the  four  cases  that  recovered.  The  disease  is 
indeed  exceedingly  characteristic,  and  may  be  recognised  even  by  the  counte- 
nance." 

Dr.  Stewardson  was  the  resident  physician  at  the  Pennsylvania  Hospital  in 
the  year  1830,  when  an  endemic  of  puerperal  fever  broke  out  in  the  lying-in 
ward  of  that  institution.  The  symptoms  which  characterized  that  epidemic, 
were  strikingly  similar  to  those  described  by  Dr.  Condie.  The  patients  all  died. 
In  those  who  were  examined  after  death,  the  appearances  were  the  same  as  are 
described  to  have  occurred  in  the  present  disease.  The  treatment  was  various; 
but  the  lancet  or  leeches,  with  blisters,  &c.,  were  resorted  to  in  most  of  the  cases. 

Nothing  arrested  the  progress  of  the  disease,  but  the  entire  evacuation  of  the 


418  Bibliographical  Notices,  [Oct. 

wards,  and  closing  them  against  farther  admissions.  Erysipelas  was  prevalent 
in  the  surgical  wards  at  the  time. 

In  the  following  year,  the  wards  were  re-opened,  soon  after  which,  three  cases 
of  the  disease  occurred  in  rapid  succession. — They,  however,  were  of  a  milder 
form,  the  pain  and  inflammation  appearing  to  be  more  local  and  circumscribed. 

The  late  Dr.  James  was  in  attendance  at  the  time.  His  practice  was  to  bleed 
moderately  in  the  beginning,  and  then  to  give  calomel  and  opium  in  repeated 
doses,  until  the  gums  were  touched.  Two  of  these  three  cases  recovered,  and 
one  died. 

Dr.  Henry  H.  Smith  stated,  that  while  in  Paris,  several  years  ago,  an  epi- 
demic of  puerperal  peritonitis  broke  out  in  the  lying-in  ward  of  the  Hopital  de 
I'Ecole  de  Medicin,  under  the  care  of  Cloquet;  erysipelas  prevailed  at  the  same 
time  in  the  surgical  wards  of  Dubois,  situated  a  short  distance  from  the  lying- 
in  department.  Cloquet  relied  chiefly  on  calomel  and  opium,  and  mercurial 
frictions,  pushed  so  as  to  induce  speedy  salivation. 

While  the  epidemic  prevailed,  most  of  the  children  born  in  the  institution 
were  still-born,  or  died  soon  after  birth  with  peritonitis.  Dr.  Smith  saw  several 
of  these  examined — and  observed  that  the  inflammation  was  confined  to  the 
peritoneum  lining  the  abdominal  parieties.  It  was  supposed  by  some  of  the 
French  pathologists,  that  the  inflammation  had  extended,  in  these  infantile  cases, 
along  the  veins  of  the  chord,  and  was  thus  communicated  to  that  portion  of  the 
peritoneum. 

In  the  adult  cases,  which  Dr.  S.  had  seen  examined,  pus  was  found  in  the 
veins  of  the  uterus — and  in  one  case,  he  saw  it  in  the  vena  cava. 

During  Dr.  Smith's  residence  in  the  Pennsylvania  Hospital,  in  the  years  1837 
and  38,  erysipelas  made  its  appearance  in  the  surgical  wards;  and  although 
every  means  were  employed  to  prevent  it,  two  cases  of  puerperal  peritonitis 
appeared  in  the  lying-in  ward.  These  were  bled  freely,  and  placed  upon  calo- 
mel and  opium,  until  the  gums  were  made  sore.  One  case  recovered,  and  the 
other  died. 

At  a  subsequent  meeting,  in  answer  to  the  queries  of  several  of  the  Fellows 
present.  Dr.  Condie  stated,  that  very  few  cases  of  puerperal  fever  had  occurred, 
in  the  southern  districts,  for  some  time  after  the  meeting  of  the  College  in  May, 
and  it  was  hoped  that  the  disease  had  entirely  ceased;  in  the  latter  part  of  June, 
however,  a  few  cases  had  again  appeared,  in  two  of  which  death  very  speedily 
ensued.  Dr.  C.  did  not  see  these  cases,  but  is  informed  by  the  gentleman 
in  whose  practice  they  had  occurred,  that  the  disease  did  not  make  its  appear- 
ance in  any  one  of  them  until  a  week  or  more  subsequent  to  parturition,  and 
when  the  females  appeared  to  be,  in  all  respects,  doing  well.  In  both  the  fatal 
cases,  the  attack  could  be  referred  to  the  ordinary  exciting  causes  of  fever  in  the 
parturient  state.  The  symptoms  diff'ered  in  nothing  from  those  by  which  the 
cases  that  occurred  in  April  were  distinguished.  Dr.  C.  is  not  aware  that  an 
autopsieal  examination  was  made  in  either. 


Art.  XXVII. —  Third  Annual  Report  of  the  Registrar-General  of  Births,  Deaths, 
and  Marriages  in  England.     London,  1841:  pp.  362,  12mo.* 

This  volume  comprises  a  general  abstract  of  the  number  of  births,  deaths, 
and  marriages  registered  during  the  year  ending  June  1840,  together  with  details 
of  exceeding  interest  to  the  professional  and  general  reader  relative  to  the  mor- 
tality in  different  districts  in  England  and  Wales,  at  different  ages,  from  various 
sources.  We  shall  proceed  to  cull  some  of  the  interesting  particulars,  and  mere- 
ly refer  to  others  which  our  limits  will  not  allow  us  to  copy. 

The  sums  total  of  births,  deaths  and  marriages  which  took  place  in  the  teem- 

*  For  notices  of  the  first  and  second  reports,  see  the  Nos.  of  this  Journal  for  Jan. 
1841,  p.  192,  and  for  July  1841,  p.  155. 


1 


1842.]  Registrar-General^ s  Third  Report.  419 

ing  populations  of  England  and  Wales  in  the  year  1839-40,  were  as  follows: — 
Births,  501,589;  deaths,  350,101;  marriages,  124,329.  The  mean  population  in 
1838-39  was  computed  at  15,666,800  of  souls,  increasing  in  10  years  at  the  rate 
of  16  per  cent.,  or  about  l\  (1.6)  per  cent,  per  annum. 

A  preponderance  is  observed  in  the  number  of  births  registered  in  the  half 
years  of  1839-40,  terminating  in  June.  Should  this  be  a  general  law,  it  will 
show  a  prevalence  of  influences  regulating  conceptions,  the  reverse  of  what  is 
observed  in  Philadelphia,  where  the  greatest  amount  of  births  always  cor- 
responds to  the  last  half  of  the  civil  year.*  Whether  this  difference  is  to  be 
ascribed  to  social  customs,  or  peculiarities  of  climate,  may  afford  a  subject  for 
discussion.  The  proportion  of  male  over  female  births  is  a  little  over  5  per 
cent,  in  the  counties,  and  a  little  under  4J  per  cent,  in  the  metropolis.  Com- 
paring these  results  with  those  observed  in  the  United  States,  peopled  with  the 
same  original  stock,  we  find  in  the  latter  a  very  striking  increase  in  the  pre- 
ponderance of  male  over  female  births.  In  the  city  of  Philadelphia,  for  exam- 
ple, the  males  at  birth  exceed  the  females  more  than  7  per  cent.,  whilst  in  the 
^country  parts  of  America,  the  excess  increases  to  at  least  10  per  cent.f 
jP'  The  number  of  marriages  annually  is  about  in  the  proportion  of  8  to  every 
thousand  of  the  population.  The  proportion  of  marriages  under  21  years  of  age 
to  the  whole  number  married  at  all  ages,  is  4.90  per  cent,  of  males,  and  14.40 
per  cent,  females.  The  greatest  amount  of  early  marriages  occur  in  the  south 
midland  counties  of  Hertford,  Bedford,  Cambridge,  Huntingdon,  Northampton, 
Leicester,  and  Essex. 

In  considering  the  subject  of  marriages,  the  opportunity  is  taken  to  throw 
light  upon  the  subject  of  education,  with  respect  to  writing,  among  the  adult 
population  of  England  and  Wales,  by  showing  the  proportion  per  cent,  in  the 
metropolis,  in  each  English  county,  and  in  North  and  South  Wales,  of  persons 
married  in  the  year  ending  June  30th,  1840,  who,  instead  of  writing  their  names 
in  the  marriage  register,  have  signed  with  marks.  It  appears,  from  the  table 
given,  that  in  13  English  counties,  in  the  West  Riding  of  Yorkshire,  and  in 
Wales,  more  than  40  per  cent,  of  the  men  married  did  not  write  their  names; 
and  that  in  19  English  counties  in  the  West  Riding  of  Yorkshire,  and  in  Wales, 
the  same  fact  existed  with  respect  to  more  than  half  of  the  women.  In  the 
whole  of  England  and  Wales,  out  of  124,329  couples,  there  were  41,812  men 
and  62,523  women  who,  it  is  presumed,  either  could  not  write,  or  wrote  very 
imperfectly.  The  proportions  for  the  metropolis  were  respectively  12  per  cent, 
of  the  men,  and  25  per  cent,  of  the  women.  The  general  average  ages  of  mar- 
riage was  for  the  males  about  27  years,  and  for  the  females  25  years. 

Thus  much  we  cull  from  the  report  of  the  Registrar-General,  T.  H.  Lister, 
to  the  Secretary  of  State  for  the  Home  Department,  the  Marquess  of  Normanby. 
The  most  interesting  topics  and  details  for  the  professional  reader  are  contained 
in  the  '''•  Ap'pendix^''  which  constitutes  about  300  pages  out  of  the  362  of  which 
the  volume  consists.  This  appendix  is  in  the  form  of  a  letter  addressed  by  Wm. 
Farr,  Esq.,  to  the  Registrar-General,  relating  to  the  causes  of  death  in  England 
and  Wales, 

It  appears,  that  of  the  whole  mortality,  the  number  of  deaths  from  the  class 
of  epidemic,  endemic,  and  contagious  diseases,  was  65,343,  and  mean  rate  of 
mortality  per  1000  by  this  class  was  4.25;  in  1838,  it  was  4.52. 

"The  decrease  was  in  small-pox  and  typhus,  16,268  persons  having  died  of 
small-pox  in  1838,  and  9131  in  1839;  18,775  of  typhus  in  1838,  and  15,666  in 
1839.  On  the  other  hand,  6514  children  died  of  measles,  and  5802  of  scarla- 
tina, in  1838;  while  10,937  died  of  measles,  and  10,325  of  scarlatina,  in  1839. 
Hooping-cough  declined.  Croup,  thrush,  diarrhoea,  dysentery,  cholera,  influ- 
enza and  erysipelas  remained  stationary;  none  of  them  assumed  the  epidemic 
form.  Ague  rose  from  44  to  95.  In  1838,  16  males  and  8  females  died  of 
hydrophobia;  in  1839,  11  males  and  4  females  perished  in  the  same  way.     Ou.$ 

*  See  Amer.  Journ.  Med.  Sci.,  vol.  ix.  p.  24, 
t  Vid.  Amer.  Journ^  loc.  eit. 


420  Bibliographical  Notices,  [Oct. 

of  n  population  of  100,000  of  each  sex,  432  males  and  418  females  died  of  the 
epidemic  class  of  diseases;  but  when  the  comparison  is  instituted  between  the 
deaths  alone  the  proportions  are  reversed;  in  100,000  deaths  of  males  19,368,  and 
in  100,000  deaths  of  females,  20,189  were  from  the  same  class  of  diseases. 

"  The  mortality  from  diseases  of  the  nervous  system  was  3.2  in  a  population 
of  1000  (500  of  each  sex):  in  1838  the  mortality  by  every  disease  of  this  class, 
except  epilepsy,  insanity,  and  delirium  tremens,  was  higher.  From  an  acci- 
dental circumstance,  too  many  deaths  are  ascribed  to  chorea  in  the  present  Ab- 
stracts; the  proportions  were  very  nearly  the  same  as  in  1838.  The  diseases  of 
the  nervous  system  were  25  per  cent,  more  fatal  to  males  than  to  females,  the 
rate  of  mortality  among  males  having  been  3.6,  among  females  2.8  in  1000. 

90,565  persons  died  by  diseases  of  the  respiratory  organs;  the  class  comprises 
27  per  cent,  of  the  deaths;  and  59,559,  or  18  per  cent,  of  the  deaths,  the  causes 
of  which  are  specified,  were  by  consumption.  At  the  adult  age,  when  consump- 
tion chiefly  prevails,  the  numbers  of  men  and  women  living  are  nearly  equal, 
yet  31,543  females  and  28,106  males  died  of  this  disease.  The  annual  rate  of 
mortality  by  consumption  was,  males  .003722,  females  .004015;  in  1838  it  was, 
males  .003783,  females  .004077,  denoting  a  slight  decrease,  which  was  more 
obvious  in  the  other  diseases  of  the  class.  659  deaths  were  ascribed  to  quinsy. 
This  augmentation  in  the  inflammatory  affections  of  the  throat  was  probably 
connected  with  the  epidemic  of  scarlatina. 

"  The  number  of  cases  registered  as  diseases  of  the  heart,  or  of  the  organs  of 
circulation^  increased  from  3562  to  3788. 

"20,767  persons  are  returned  as  having  died  by  diseases  of  the  digestive 
organs,  namely,  3990  by  diseases  of  the  liver,  29  by  diseases  of  the  spleen,  4 
by  diseases  of  the  pancreas,  and  16,744  by  diseases  of  the  stomach  and  intes- 
tines. The  mortality  from  this  class  was  1.351  in  1000;  it  was  1.287  in  the 
year  preceding.  If  we  add  the  deaths  from  thrush  (1019),  diarrhoea  (2562), 
dysentery  (537),  and  cholera  (394),  to  the  class,  it  will  make  25,279,  which  is 
to  the  deaths  by  diseases  of  the  respiratory  organs  (90,565),  after  adding  to 
them  8165  deaths  by  hooping-cough,  4192  by  croup,  and  887  by  influenza, 
nearly  in  the  proportion  of  1  to  4. 

"  Diseases  of  the  skin  and  integumentary  system  destroyed  420  persons  in 
1838,  and  448  in  1839.  The  exanthematous  fevers,  with  eruptions  on  the  skin 
— small-pox,  measles,  scarlatina,- and  erysipelas — proved  fatal  to  29,787  persons 
in  1838,  and  31,533  in  1839:  when  half  the  number  (15,666)  died  of  typhus, 
which  is  generally  accompanied  by  rose  spots  upon  the  skin,  petechias,  or  ulcer- 
ations of  the  intestinal  glands  of  Peyer. 

"  1275  males,  and  259  females,  died  of  diseases  of  the  urinary  organs;  the 
rate  of  mortality  was,  males  169,  females  33,  in  1,000,000. 

^^Child-birth  was  fatal  to  2915  women;  out  of  1,000,000  females  living,  368 
died  by  this  cause  in  1838,  and  372  in  1839.  About  five  births  in  1000  are  fatal 
to  the  mother.  It  is  to  be  regretted  that  no  sign  of  diminution  is  perceptible  in 
this  class  of  deaths. 

"Diseases  o^' the  joints,  bones,  and  muscles  destroyed  1098  males,  and  922 
females.  White  swelling,  lumbar  abscess,  and  other  scrofulous  affections,  con- 
stituted a  considerable  number  of  the  cases. 

"The  deaths  registered  as  ' Inflammation,' without  any  specification  of  the 
part  aflfected,  amounted  to  5816  in  1838,  and  4940  in  1839.  The  decrease  de- 
notes an  improvement  in  the  registration,  for  the  term  is  vague  and  highly  objec- 
tionable. If  the  existence  of  inflammation  has  been  ascertained,  the  part  affected 
must  be  known,  and  should  be  stated.  The  mortality  from  dropsy  and  hemor- 
rhage was  less;  from  cancer  greater  than  in  1838.  The  head  "  Debility"  com- 
prises premature  births,  and  the  cases  of  infants  who  died  -within  a  few  hours 
after  birth  without  any  very  apparent  cause.  Our  knowledge  of  the  diseases  of 
infants,  and  of  old  people,  is  still  imperfect;  and,  it  is  exceedingly  probable,  that 
as  the  science  of  pathology  advances,  the  deaths  from  "debility"  and  "old 
a^e,"  which  amounted  in  1839  to  15,143,  and  35,063,  will  undergo  considerable 
diminution." 


1842.]  Registrar-GeneraVs  Third  Report.  421 

Violent  deaths.-— The  number  classed  under  this  head  for  1839,  is  11,980,  the 
proportions  at  different  ages,  in  different  parts  of  the  country,  and  at  different 
seasons  being  about  the  same  as  in  the  previous  year. 

In  England  and  Wales,  about  2400  persons  are  drowned  every  year,  in  addi- 
tion to  about  1000  lives  estimated  to  be  annually  lost  by  shipv^^reck  in  sailing 
vessels  alone. 

Burns,  from  their  clothes  taking  fire,  are  the  most  common  causes  of  violent 
deaths  in  females;  77  males  and  159  females  (two-fiflhs  of  the  females  who 
perished  by  violence),  died  of  burns  in  the  metropolis. 

The  tendency  to  commit  suicide  appears  to  increase  up  to  the  age  of  60,  and 
to  be  then  three  times  as  great  as  at  the  age  of  25.  The  greatest  number  of 
suicides  occurred  in  the  spring  and  summer,  when  crimes  attended  by  violence, 
and  attacks  of  insanity  are  also  most  common.  The  general  rate  of  mortality 
from  violence  ranges  from  509  to  1015  in  100,000,  the  highest  rate  being  in  the 
mining  and  manufacturing  districts,  the  lowest  in  the  agricultural  districts. 
The  metropolis  occupies  an  intermediate  place.  The  mortality  of  males  by  vio- 
lent deaths  is  as  26  to  10  females,  and  the  tendency  to  suicide  nearly  in  the 
same  proportion.  Exclusive  of  suicides  and  deaths  at  sea,  about  4367  men  in 
the  prime  of  life  are  cut  off  every  year  in  England  by  injuries  and  accidents 
of  various  kinds. 

On  the  authority  of  Mr.  Curling,  one  of  the  surgeons  of  the  London  Hospital, 
2445  patients  were  admitted  in  1839,  on  account  of  accidents,  of  which  number 
129  died,  the  mortality  being  1  in  19.  Nearly  12  men  in  10,000,  (exclusive  of 
sailors  and  soldiers,)  aged  20  years  and  upwards,  died  violent  deaths  in  the 
metropolis,  and  from  the  best  estimate  that  can  be  made  from  the  recorded  ver- 
dicts, 5  of  the  12  were  suicides.  One  in  2000  men  committed  suicide  in  the 
year.  The  tendency  to  commit  suicide  is  least  among  persons  who  carry  on 
occupations  out  of  doors;  and  greatest  among  artisans  who  are  weakly  from 
birth,  and  confined  in  doors,  have  their  rest  disturbed,  or  have  little  muscular 
exercise. 

"Taking  the  numbers  as  they  stand,  1  in  9332  masons,  carpenters,  and 
butchers  committed  suicide  in  the  year;  and  1  in  1669  tailors,  shoemakers,  and 
bakers:  the  tendency  to  suicide  in  the  first  class  was  as  1.0  to  5.6  in  the  second. 
The  corrected  mortality  from  suicide  was  1.33  to  10,000  in  the  first  class,  and 
7.43  to  10,000  in  the  second  class.  The  requisite  correction  will  be  made, 
without  further  notice,  in  the  subsequent  rates.  It  does  not  affect  the  relative 
mortality  of  different  classes. 

"  A  similar  result  is  obtained  by  comparing  the  suicides  in  the  class  of  labour- 
ers with  those  among  artisans  and  tradespeople;  for  the  tendency  to  suicide  is 
twice  as  great  among  artisans  as  it  is  among  labourers. 

"The  proportion  of  suicides  in  the  miscellaneous  class,  designated  by  Mr. 
Rickman,  '  capitalists,  bankers,  professional  and  other  educated  men,^  is  very  near 
the  average. 

Numbers.  Suicides,  Other  Violent  Deaths.  Suicides  in  10,000 

55,853  22  23  4.9 

"The  subjoined  entries  were  referred  to  this  head,  which  is  not  very  clearly 
defined. 

"It  has  been  remarked  by  theoretical  writers  who  appear  to  have  had  this 
class  principally  in  view,  that  suicide  is  most  prevalent  in  countries  where  the 
greatest  number  of  people  are  educated;  and  M.  Brouc,  after  an  elaborate  in- 
quiry, lays  it  down  as  a  '  social  law,'  that  suicide  is  most  common  where  edu- 
cation is  the  most  diffused;  that  suicides  and  scholars  increase  in  the  same  ratio. 
Modern  education  and  literature,  it  is  said,  have  led  to  an  increase  in  the  num- 
ber of  suicides.*  In  England  suicide  is,  in  fact,  most  frequent  in  the  metropolis, 

*  Considerations  sur  les  Suicides  den6tre  epoque.  Par  M.  B^ouc,  Annates  d^Hygiene. 
Tome  16,  p.  223. 

No.  VIII.— October,  1842.  36 


422  Bibliographical  Notices.  [Oct. 

the  south-eastern  counties,  and  the  northern  counties,  where  the  greatest  num- 
ber can  write:  and  it  is  the  least  frequent  in  Wales.  The  intermediate  counties 
range  from  62  to  48,  who  could  write,  in  100;  the  suicides  from  4.5  to  6.8  in 
100,000. 

"  There  is  a  general,  but  no  constant  relation  between  the  state  of  education 
thus  tested,  and  the  commission  of  suicide.  It  may  be  admitted  that  there  is 
some  relation  between  the  development  of  the  intellect  and  self-destruption;  but 
the  connection  must  be  in  a  great  measure  indirect  and  accidental.  In  opposi- 
tion to  the  arguments  derived  from  agricultural  districts,  and  labourers  in  towns, 
there  is  the  fact  that  suicide  is  more  frequent  among  several  classes  of  artisans, 
than  it  is  among  better  educated  people.  If  the  progress  of  civilization  is  to  be 
charged  with  the  increase  of  suicide,  we  must  therefore  understand  by  it  the 
increase  of  tailors,  shoemakers,  the  small  trades,  the  mechanical  occupations, 
and  the  incidental  evils  to  which  they  are  exposed,  rather  than  the  advancement 
of  truth,  science,  literature,  and  the  fine  arts. 

"  A  comparison  of  the  suicides  among  servants  and  the  preceding  class  would 
throw  some  light  on  the  influence  of  mental  cultivation.  But  servants,  com- 
prising coachmen,  cannot  be  distinguished  from  street  coach-drivers  in  the 
registers, — so  that  the  two  classes  must  be  referred  to  one  head;  standing  in 
point  of  education,  however,  nearly  on  a  level. 

"  In  corroboration  of  this  result,  it  maybe  stated  that  about  2.0  in  10,000 
persons  assured  in  the  Equitable  Society,  and  7.8  in  10,000  Dragoons  and  Dra- 
goon Guards,  have  been  ascertained  to  commit  suicide  every  year.* 

"  Of  26,665  paupers,  and  others  not  included  in  the  previous  classes,  9  com- 
mitted suicide,  or,  with  the  CQrrection,  4  in  10,000.  It  does  not  appear  from 
the  registers,  that  either  poverty  or  riches  have  any  great  disturbing  influence 
on  the  tendency  to  suicide.  The  influences  of  their  attendant  evils  are  nearly 
equal.  The  poor  man  has  an  average  standard  of  enjoyment  which  he  can 
scarcely  fall  below,  and  is  less  exposed  to  cruel  reverses  than  the  affluent;  who 
are,  on  the  other  hand,  assured,  by  the  abundance  of  their  resources,  against  the 
frequent  fluctuations  in  the  supply  of  the  primary  necessaries  of  life. 

Intemperance  and  suicide,  as  well  as  other  violent  deaths,  are  found  asso- 
ciated in  the  registers;  and  the  professions  peculiarly  addicted  to  drunkenness 
have  more  than  the  due  proportion  of  suicides.  Drunkenness  leads  to  this;  but 
drunkenness  is  a  sort  of  indirect  suicide,  and  both  are  tendencies  of  the  mind, 
indulged  often  from  the  same  motives,  and  promoted  by  similar  causes;  for  in 
drunkenness  the  wretched  find  not  only  the  gratification  of  an  appetite,  but  the 
suspension  of  natural  consciousness — in  death  they  seek  its  cessation. 

"There  is  no  reason  to  believe  that  suicide  has  been  latterly  increasing  in 
England.  The  fact,  nevertheless,  that  1000  persons  are  ascertained  to  commit 
suicide  yearly,  and  that  nearly  as  many  more  are  returned  as  drowned,  &c.,  in 
which  the  verdicts  do  not  state  w^hether  death  was  accidental  or  suicidal,  is  suf- 
ficient to  arrest  attention  on  all  the  relations  of  the  question. 

"Some  plan  for  discontinuing,  by  common  consent,  the  detailed,  dramatic 
tales  of  suicide,  murder,  and  bloodshed  in  the  newspapers  is  well  worthy  the 
attention  of  their  editors.  No  fact  is  better  established  in  science  than  that  sui- 
cide (and  murder  may  perhaps  be  added)  is  often  committed  from  imitation.  A 
single  paragraph  may  suggest  suicide  to  twenty  persons;  some  particular,  chance, 
but  apt  expression,  seizes  the  imagination,  and  the  disposition  to  repeat  the  act, 
in  a  moment  of  morbid  excitement,  proves  irresistible.  Do  the  advantages  of 
publicity  counterbalance  the  evils  attendant  on  one  such  death?  Why  should 
cases  of  suicide  be  recorded  at  length  in  the  public  papers,  any  more  than  cases 
of  fever]  It  would  be  out  of  place  to  refer  here  to  the  moral  or  strictly  medical 
treatment;  but  it  may  be  remarked,  that  the  artisans  most  prone  to  suicide  are 
subject  to  peculiar  visceral  congestions — that  suicide  is  most  common  in  un- 
healthy towns — and  that  the  influence  of  medicine  on  the  mind,  and  on  the 

*  Tables  of  Equitable  Society,  1834,  p.  23.  Army  Statistical  Reports,  1839,  "The 
United  Kingdom,"  p.  7. 


I 


1842.]  Registrar-GeneraV s  Third  Report.  4^3 

unstable  ungovernable  impulses  which  are  often  the  harbincrers  of  suicide — is 
incontestable.  To  place  the  shoemaker,  tailor,  baker,  or  printer  in  the  same 
favourable  circumstances  \fith  respect  to  air  and  exercise  as  carpenters  and 
masons  would  be  impossible.  But  the  workshops  of  all  artisans  admit  of  im- 
mense improvements  in  ventilation.  Cleanliness  is  greatly  neglected.  Neither 
the  men  nor  all  the  masters  appear  to  be  aware  that  the  respiration  of  pure  air  is 
indispensable;  that  the  body  requires  as  much  especial  care  as  the  tools,  instru- 
ments, and  machines,  and  that  without  it,  neither  the  body  nor  the  mind  can  be 
preserved  in  health  and  vigour.  The  new  parks  and  public  walks  will  afford 
the  artisan  an  opportunity  of  refreshing  his  exhausted  limbs  and  respiring  the 
fresh  air;  and  the  health  and  temper  of  the  sedentary  workman  may  be  much 
ameliorated  by  affording  facilities  in  towns  for  athletic  exercises  and  simple 
games  out  of  doors,  which,  while  they  bring  the  muscles  into  play,  unbend, 
excite,  and  exhilarate  the  mind.  Moral  causes,  and  the  regulation  of  the  mind, 
have  perhaps  more  influence  on  the  educated  classes;  but  all  must  derive  benefit 
from  out-door  exercise. 

"The  mortality  of  males  aged  20  from  other  violent  deaths  was  6.77.  As  a 
general  rule  the  suicides  were  most  numerous  in  the  trades  least  exposed  to 
accidents;  as  if  the  mind,  left  unexcited  by  natural  dangers,  imagined  and  cre- 
ated causes  of  death.  Three  in  10,000  tailors,  bakers,  shoemakers,  and  9  in 
10,000  masons,  carpenters,  and  butchers,  were  killed  by  accidents  or  violence, 
the  reverse  of  the  proportions  in  suicide.  The  degree  of  danger  which  besets 
the  different  classes  of  the  community  in  their  occupations,  is  shown  by  the 
following  facts. 

"Eighty-six  sailors,  watermen,  or  fishermen,  died  violent  deaths.  As  the 
number  of  seamen  cannot  be  ascertained  until  the  returns  of  the  census  are  made 
up,  the  mortality  by  violence  among  them  cannot  be  calculated.  It  was  un- 
doubtedly higher  than  in  any  of  the  preceding  classes.  The  occupation  of 
engineer  is  at  present  the  most  dangerous  followed;  21  engineers,  stokers,  and 
firemen,  were  killed  in  one  year  in  the  metropolis,  and  that  chiefly  in  the  steam- 
vessels  on  the  Thames." 

It  is  a  question  of  some  interest  whether  the  proportion  of  deaths  by  violence 
is  greater  or  less  than  in  former  times.  In  the  investigation  of  this  subject, 
Mr.  Farr  refers  to  the  London  bills  of  mortality  to  furnish  data  from  which  some 
approximation  to  the  proportion  of  deaths  by  violence  to  the  deaths  from  all 
other  causes,  may  be  ascertained  so  far  as  the  metropolis  is  concerned,  from  the 
middle  of  the  17th  century. 

"In  the  first  period  (1647  to  1700)  the  annual  rate  of  mortality  was  about  7, 
in  the  second  5.2,  in  the  third  5,  in  the  fourth  3  per  cent.;  whence  it  may  be 
deduced  that,  in  the  17th  century  6.8  in  100,000,  in  the  18th  century  5.4,  in  the 
19th  century  5,  died  violent  deaths.  Out  of  a  given  amount  of  population,  the 
deaths  by  drowning  increased  in  the  latter  half  of  the  18th  century;  the  deaths 
by  scalds  and  burns  were  twice  as  great  in  1800 — 1830  as  in  the  17th  century. 
The  tendency  to  suicide  remained  nearly  stationary;  so  did  death  by  poisoning. 
All  the  deaths  by  personal  violence  rapidly  decreased.  In  a  population  of 
100,000,  according  to  these  accounts,  about  23  were  killed,  4.6  murdered,  in  the 
17th  century;  in  the  18th  century  about  13  were  "killed,"  and  0.5  were  mur- 
dered. The  chance  of  being  murdered  diminished  nine-fold.  The  executions 
were  more  frequent  in  the  latter  half  than  in  the  beginning  of  the  18th  century, 
compared  with  the  population  within  the  Bills  of  Mortality;  they  were  not, 
however,  half  so  frequent  in  the  first  30  years  of  the  19th  century  as  in  the  lat- 
ter half  of  the  18th  century,  when  about  7  were  executed  annually  to  a  popu- 
lation of  10,000.    Relatively  to  the  murders  the  number  of  executions  increased. 

"It  is  scarcely  necessary  to  say  that  few  criminals  are  now  punished  capi- 
tally." 

A  comparison  of  the  deaths  from  violence  in  four  of  the  great  states  of  Eu- 
rope shows  the  largest  proportions  in  England  and  Sweden.  Prussia  exhibits 
a  much  lower  proportion,  and  France  but  little  more  than  half  that  of  Prussia. 
But  the  number  of  suicides  is  far  greater  in  France,  and  still  larger  in  Prussia. 


424  Bibliographical  Notices,  [Oct. 

Thus  the  proportion  of  violent  deaths  in  100,000  of  the  population  of  Sweden 
(1810  to  1830)  was  67.7,  the  suicides  comprising  5.1;  in  England  and  Wales 
(1838,  1839)  74.5,  the  suicides  being  6.4;  in  Prussia  (1820  to  1834)  48.6,  the 
suicides  constituting  9;  in  France  (1839)  26.8,  the  suicides  being  8.  In  regard 
to  this  comparison,  Mr.  Farr  observes — 

"  Neither  the  Prussian  nor  French  returns  appear  to  comprise  deaths  by  ho- 
micide, which  would  not,  however,  affect  the  results  to  any  great  extent.  The 
French  returns  are  evidently  defective;  they  profess  to  give  all  the  accidental 
deaths  which  came  to  the  knowledge  of  the  minister  of  justice,  who  is  not  paid 
on  the  same  principle  as  the  coroners  of  this  country.  If,  instead  of  27,  we 
admit  that,  exclusive  of  homicide,  37  in  100,000  Frenchmen  met  their  deaths  by 
violence  in  the  year,  this  will  make  little  more  than  half  the  mortality  by  vio- 
lence in  England;  where,  after  every  deduction  has  been  made  for  defects  in  the 
foreign  returns,  the  mortality  by  violent  deaths  is  greater  than  in  Sweden,  Prus- 
sia, France,  and  probably  any  nation  of  Europe,  in  which  civil  war  is  not  raging. 

"The  reason  of  this  is  explained  by  the  preceding  analysis,  without  implying 
any  extraordinary  negligence.  Relatively  to  the  population  of  England,  few 
countries  have  such  an  extent  of  coast,  rivers,  and  canals,  or  so  many  men  em- 
ployed in  navigation;  so  many  fires,  furnaces,  and  chemical  processes  in  opera- 
tion; medicines  and  poisons  distributed  in  so  many  shops;  so  many  mines, 
manufactures,  or  buildings;  so  many  horses,  carriages,  and  railways;  such  a 
vast  amount  of  force  of  every  description  at  its  disposal.  The  great  number  of 
violent  deaths  in  England  may,  therefore,  be  accounted  for  on  the  assumption 
that  the  danger  in  the  manufactures,  mines,  and  conveyances,  is  the  same  as  in 
other  countries;  but  that  the  frequency  of  exposure  to  it  is  greater." 

Murders. — The  murders  registered  in  two  years  amounted  to  156,  103  of 
which  were  males,  and  53  females.  Of  148  persons  murdered,  78  were  aged 
20  and  upwards.  If  infants  be  excluded,  the  greatest  proportion  of  murders 
occurred  in  Lancashire  and  Cheshire;  the  smallest  proportion  in  Essex,  Suffolk, 
and  Norfolk. 

Lightning. — Twenty-five  persons  (18  males  and  7  females),  were  killed  by 
lightning  in  1838,  and  18  (14  males  and  4  females),  in  1839.  In  the  last  two 
quarters  of  IS37 ,  Jif teen;  and  of  1838,  fourteen;  and  of  1839,  only  ^wo  deaths 
were  caused  by  lightning.  In  the  two  years  1838-9,  1  of  the  deaths  occurred 
in  May,  26  in  June,  8  in  July,  4  in  August,  2  in  September,  and  2  in  Novem- 
ber. Six  was  the  greatest  number  killed  in  one  storm,  which  happened  on  the 
18th  of  June,  1839;  and  it  is  a  curious  coincidence  that/our  persons  were  struck 
dead  by  lightning  on  the  18th  of  June,  1838. 

"The  danger  of  being  struck  by  lightning  is  comparatively  not  very  great; 
for  only  22  are  killed  by  this  cause  in  the  year,  while  29  die  other  violent 
deaths  dailt/,  exclusive  of  suicides.  Of  a  million  men  at  the  age  when  they  are 
most  exposed  (30-50),  not  more  than  4  were  struck  dead;  while  the  proportion 
of  women  was  less  (1.5).  During  the  thunder-storm,  however,  the  danger  of 
death  by  lightning  is  probably  twice  as  great  as  the  danger  at  that  time  from  all 
the  other  causes  of  violent  death  put  together.  Franklin  wrote  popular  direc- 
tions as  to  the  best  means  of  protection  in  storms,  but  it  appears  from  M.  Arago's 
interesting  paper,*  that  natural  philosophers  are  not  agreed  altogether  in  admit- 
ting their  propriety.  Unless  there  is  something  in  the  structure  or  dress  of  men 
which  marks  them  out  in  a  special  manner  as  victims  of  the  lightning,  it  may 
be  inferred  from  the  facts  in  the  registers  that  people  are  safest  in-doors  when  it 
lightens;  and  that  women  and  children  are  placed  in  the  circumstances  where 
there  is  least  danger." 

Sudden  Deaths. — Of  the  deaths  reported  under  this  head  by  the  verdicts  of  the 
coroners'  juries,  nearly  2  out  of  3  have  no  cause  stated. 

"  Apoplexy  was  said  to  be  the  cause  of  53  deaths,  diseases  of  the  heart  and 
arteries  of  28,  exclusive  of  10  ascribed  to  a  rupture  of  a  blood-vessel.  Fits  and 
convulsions  come  next  in  the  order  of  frequency.     Several  of  the  sudden  deaths 

*  Annuaire  de  France^  1839. 


1842.]  Registrar-GeneraV s  Third  Report,  425 

happened  in  the  course  of  chronic  diseases,  but  the  cases  of  consumption  oc- 
curred principally  among;  criminals  in  the  prisons,  and  were  not  sudden  deaths. 
In  1087  other  cases  which  occurred  in  the  metropolis  (1839),  the  deaths  were 
ascribed  to  apoplexy  84  times,  convulsions  17  times,  epilepsy  10  times,  heart 
diseases  36  times,  and  rupture  of  a  blood-vessel  36  times.  The  verdicts,  'visi- 
tation of  God,'  or  'natural  death,'  were  returned  632  times  in  the  1087 
inquests,  not  comprising  violent  deaths. 

"No  definition  of  the  sense  in  which  'sudden  death'  is  practically  under- 
stood by  the  coroners  has  been  given;  nor  can  we  describe  in  any  precise  terms 
the  class  of  cases,  exclusive  of  violent  deaths,  which  are  comprised  in  the  ab- 
stracts of  inquests.  The  writers  even  on  medical  jurisprudence  do  not  state 
with  any  strictness  what  they  mean  by  sudden  deaths — whether  it  be  death  in 
10  minutes,  10  hours,  or  10  days;  but  it  is  generally  applied  to  cases  where  per- 
sons, previously  able  to  attend  to  business,  are  suddenly  deprived  of  conscious- 
ness, and  expire  in  less  than  25  hours.  Understood  in  this  sense,  it  is  the 
popular  opinion  that  '  sudden  death'  is  the  result  of  apoplexy,  when  it  is  not 
produced  by  violence.  The  recent  researches  of  M.  Devergie  prove  that  the 
opinion  is  a  popular  error;  and  if  M.  Devergie's  theory  be  rejected,  his  facts 
prove  satisfactorily  that  the  'apoplectic  theory'  rests  on  no  solid  grounds. 
Many  of  the  verdicts  which  ascribe  '  sudden  death'  to  apoplexy  must  be  erro- 
neous." 

In  Paris,  as  is  well  known,  all  bodies  found  dead  and  not  recognized  are  con- 
veyed to  a  place  called  the  morgue,  where  they  and  their  clothes  are  carefully 
kept  and  exhibited  for  the  purpose  of  recognition  by  their  friends  or  other  per- 
sons. The  medical  director  of  the  morgue  is  M.  Devergie,  who  has  the  most 
ample  opportunities  for  investigating  the  causes  of  sudden  deaths,  which,  after 
Bichat,  he  refers  to  the  three  principal  organs; — the  lungs,  brain,  and  heart. 

"In  death  by  the  lungs,  the  circulation  is  stopped  primarily  in  those  organs; 
the  pulmonary  artery,  the  right  cavities  of  the  heart,  and  the  vense  cavas  are 
gorged  with  blood.  The  pulmonary  veins,  the  left  cavities  of  the  heart,  and  the 
aorta  are  empty,  or  contain  an  infinitely  small  portion  of  blood.  In  death  by  the 
brain  (apoplexy),  the  respiration  is  embarrassed,  the  lungs  congested,  and  then 
the  heart  ceases  to  beat;  the  meningeal  veins  are  gorged  with  blood;  the  lungs 
contain  a  considerable  quantity;  there  is  blood  in  both  sides  of  the  heart,  but 
most  in  the  right  cavites.  If  death  begin  at  the  heart,  {syncope,  fainting),  its 
action  ceasing  all  at  once,  the  cavities  are  full  on  both  sides,  not  as  they  are  in 
the  state  of  accumulation,  but  as  in  the  ordinary  state  of  the  circulation;  there  is 
blood  in  the  arteries  and  veins.  Neither  the  lungs  nor  the  brain  are  congested. 
This  is  a  brief  summary  of  the  results  of  M.  Devergie's  researches.  The  term 
congestion  is  vague,  and  by  no  means  unobjectionable;  but  it  is  often  all  that  is 
found  in  violent  death  by  asphyxia,  and  it  has  something  like  a  specific  mean- 
ing in  M.  Devergie's  essay;  who  reports  several  cases  at  length,  which  medical 
witnesses  will  do  well  to  consult. 

"  The  following  is  a  summary  of  40  cases  of  sudden  death,  carefully  examined 
by  the  medical  director  of  the  morgue:* — 

"Apoplexy,  with  a  clot  in  the  annular  protuberance,  1;  meningeal  apoplexy, 
3;  serous  apoplexy  and  pulmonary  congestion,  2;  congestion  of  the  brain  and 
spinal  marrow,  3;  pulmonary  congestion,  12;  pulmonary  and  cerebral  conges- 
tion, 12;  hsematemesis,  2;  syncope,  3;  rupture  of  the  heart,  1;  rupture  of  the  pul- 
monary artery,  1." 

Although  the  coroner's  inquest  was  instituted  at  a  time  when  homicide  was  a 
much  more  frequent  cause  of  death,  than  at  present,  and  hence  was  undoubtedly 
intended  to  detect  deaths  from  such  a.  seurce,  the  custom  now  is  by  no  means 
confined  to  this  legitimate  purpose.  This  may  be  inferred  from  the  fact  that  of 
35,000  inquests  held  in  two  years,  1838-9,  only  156  murders  were  registered. 
There  was,  moreover,  but  one  verdict  of  murder  to  224  inquests.  According  to 
the  criminal  returns,  121  offenders  were  tried  for  murder  in  1838-9,  of  which 

*  Medecine  Legale^  torn.  i.  p.  66. 
36* 


436  Bibliographical  Notices.  [Oct. 

number  only  37  were  convicted,  and  15  were  executed.  The  number  of  deaths 
by  manslaughter  was  inconsiderable. 

"The  primary  question  in  every  inquest  unquestionably  is; — Was  the  death 
the  result  of  homicide'?  And  even  this  can  only  be  satisfactorily  answered  by 
strictly  complying  with  the  provision  of  the  Registration  Act,  and  inquiring 
into  the  particulars  of  the  actual  cause  of  death.  Exclusive  of  the  use  of  the 
deodand  in  preventing  accidents,  however,  the  principal  utility  of  the  inquest 
is  the  security  which  it  affords  the  public  mind;  and  its  tendency  to  prevent 
crime,  by  convincing  the  evil-minded  that  murder  cannot  be  committed  with  any 
chance  of  impunity.  But  inquests,  in  which  the  'cause  of  death'  is  not  in- 
quired into,  can  neither  inspire  criminals  with  dread,  nor  the  public  with  confi- 
dence. The  most  important  part  of  the  evidence  of  the  inquest  is  omitted,  when 
the  'cause  of  death'  is  not  investigated.  The  expense  of  inquests,  which  is 
now  not  considerable,  would  be  slightly  augmented;  but  the  value  of  the  infor- 
mation, and  the  use  of  the  inquiry,  would  be  increased  in  an  infinitely  greater 
degree.  The  legislature,  moreover,  has  left  the  coroners  no  discretion  upon 
this  matter.  The  juries  are  bound  by  the  Act  to  inquire  into  the  particulars 
required  by  you;  and  the  coroners  are  bound  to  supply  the  registrars  with  the 
results— comprising  an  intelligible  statement  of  the  '  cause  of  death,'  so  far  as 
it  can  be  ascertained.  The  inquests  in  England  will,  henceforward,  be  as  effi- 
cient as  similar  inquiries  in  France  or  Germany;  and  be  placed  on  a  level  with 
the  present  state  of  medical  jurisprudence, — to  contribute  to  that  branch  of  sci- 
ence an  immense  number  of  new,  well-authenticated,  and  instructive  facts." 

Deaths  in  the  London  Hospitals. — Separate  abstracts  have  been  made  of  the 
causes  of  death  in  the  London  hospitals, — 13  in  number,  the  mortality  in  which 
within  the  year,  amounted  to  2491,  1729  of  which  were  males,  and  762  females. 
The  number  of  patients  admitted  is  not  stated.  The  mortality  in  the  hospitals, 
constitutes  5^  per  cent,  of  the  total  deaths  in  the  metropolis. 

Deaths  from  Diseases  in  Towns  and  in  the  open  Country. — The  general  princi- 
ples bearing  upon  this  highly  interesting  subject  have  been  discussed  in  the 
former  reports,  where  the  particular  circumstances  or  agencies  believed  to  in- 
crease the  mortality  of  towns,  and  dense  populations  of  every  kind  are  referred 
to.  A  table  is  presented,  showing  the  results  of  two  years'  observations  (1838-9) 
combined.  The  number  of  deaths  by  different  causes  in  the  metropolis,  and 
twenty-four  principal  towns  or  city  districts,  as  contrasted  with  the  deaths  from 
the  same  causes  in  counties  containing  a  less  dense  population,  chiefly  engaged 
in  agriculture. 


Area  in 
square 
miles. 

Estimated 
population 
Jan.  1, 1840. 

Deaths 
registered 
in  2  years. 

Inhabitants 

lo  one  square 

mile. 

Annual 
mortality 
per  cent. 

Country  Districts, 
Town  Districts, 

17,254 

747 

3,559,323 
3,769,002 

129,628 
197,474 

206 
5,045 

1.821 

2.620 

This  difference  is  greater  than  that  given  in  the  calculation,  founded  on  the 
facts  observed  in  1838,  when  the  deaths  in  Bristol,  Clifton,  and  Norwich, 
were  (by  error)  not  subtracted  from  the  deaths  in  the  counties  of  Gloucester- 
shire and  Norfolk.  The  mortality  in  the  town  districts  declined,  however,  in 
1839,  more  than  the  mortality  in  the  country  districts. 

Deaths  of  Children. — The  diseases  chiefly  incidental  to  childhood,  are  twice 
as  fatal  in  the  town  districts  as  they  are  in  the  country.  This  is  strikingly  exhi- 
bited in  the  following  condensed  statement. 

Deaths  in  1,000,000 

living  in  the 

Country.  Towns. 

By  Hydrocephalus,  Cephalitis,        -    -    -    419  1071 

"  Convulsions,  Teething,         .    -    -    -    942  2586 

"  Pneumonia,        905  2028 

*♦  Smallpox,  Measles,  Scarlatina,  ^ 

Hooping-cough,  Croup,  5  1999  4014 


i 


1842.]  Begistrar-GeneraVs  Third  Report.  427 

Deaths  of  Old  Persons. — The  deaths  by  several  diseases,  of  old  agfe,  were 
almost  equally  numerous  in  the  towns  and  the  country.  Asthma,  it  will  how- 
ever be  seen,  forms  an  exception. 

Deaths  in  1,000,000 
living  in  the 
Country.  Towns. 

Old  Age,  -     -     - 2446  1922 

Paralysis, 333  334 

Apoplexy, 374  409 

Asthma,  182  645 

It  must  be  borne  in  mind,  that  the  number  of  children  and  old  people  living 
in  the  towns  is  less  than  in  the  country  districts;  while  the  number  of  persons  in 
the  middle  of  life,  is  proportionally  greater  in  the  towns  than  in  the  country. 

[t  will  be  seen  by  the  following  table,  that  several  diseases  very  frequently 
fatal,  occurring  between  the  ages  of  15  and  60,  were  from  25  to  50  per  cent. 
more  fatal  in  the  town  than  in  the  country  districts. 

Deaths  registered  in  the 

Country  Districts.  Town  Districts.         Excess  of  Deaths 

in  Towns. 

Typhus,  6,462  10,582  55  per  cent. 

Consumption,  24,094  32,436  24  "  " 

Hepatitis  and  Diseases  7  ,  ^oc  ■,  r-oi  qq  h  ll 

of  the  Liver,                 5  ^'"^^  ^'^'^'^  ^^ 

Diseases  of  Childbearing,  909  1,560  59  "  " 

Rheumatism,  324  531  52  '«  '* 

Paramenia,  19  35  70  «  » 

The  tendency  to  consumption,  it  will  thus  be  seen,  is  increased  24  per  cent., 
and  to  typhus  55  per  cent.,  in  the  town  districts;  but  as  the  absolute  mortality 
from  consumption  is  three  times  as  great  as  from  typhus  in  towns,  and  nearly 
four  times  as  great  in  the  country,  the  excess  of  deaths  by  consumption,  caused 
by  the  insalubrity  of  towns,  is  greater  than  the  excess  of  deaths  by  typhus — a 
fact  which  has  hitherto  been  overlooked.  Thus,  24,094  deaths  from  consump- 
tion occurred  in  the  country,  32,436  in  the  town  districts;  the  excess  amounted 
to  8342  deaths;  6204  deaths  from  typhus  occurred  in  the  country,  10,852  in  the 
town  districts;  the  excess  amounted  to  4450  deaths.  These  facts,  Mr.  Farr 
thinks,  show  the  propriety  of  the  ordinary  medical  advice  to  place  persons  of  a 
consumptive  habit  in  a  pure  atmosphere;  but  they  militate  against  sending  them 
to  reside  in  the  continental  towns,  in  many  of  which  the  mortality  is  as  high  as  it 
is  in  Bethnel  Green  and  Whilechapel.  Paramenia,  (mismenstruation),  though 
rarely  fatal,  is  a  very  common  disease,  and  one  which  greatly  embarrasses  the 
medical  practitioner.  The  facts  in  the  table  point  out  the  utility  of  the  country 
watering-places  to  patients  afflicted  with  the  complaint  in  cities.  The  excess 
of  deaths  by  childbirth  in  the  town  districts  is  striking.  Out  of  nearly  the  same 
number  of  deliveries,  909  mothers  died  in  the  country,  1560  in  the  town  dis- 
tricts. 

Referring  to  the  mortality  in  the  metropolis,  and  the  means  by  which  this  is 
diminished  or  increased,  Mr.  Farr  observes  that — 

"The  mortality  increases,  caeieris paribus,  as  the  density  of  the  effluvial  poi- 
son generated  in  cities,  and  not  strictly  as  the  density  of  the  population.  The 
indigence  of  the  inhabitants,,  or  an  insufficiency  of  proper  food — even  when  not 
carried  to  the  extent  of  starvation  or  famine — has  also  a  decided  effect  on  the 
production  of  effluvial  poisons,  as  well  as  on  the  tendency  to  diseases  of  every 
kind.     Hence  the  mortality  is  not  always  greatest  in  the  densest  parts  of  cities. 

"This  principle  explains  the  facts  that,  although  the  mortality  is  increased 
44  per  cent,  by  the  present  condition  of  the  towns  in  England — where  the  pro- 
portion of  town  population  is  greater  than  in  any  other  country  in  Europe,  except 
Belgium, — the  mortality  of  the  nation  has  been  much  below  the  average  during 
the  whole  of  the  present  century;  and,  up  to  the  present  day,  the  expectation  of 


428  Bibliographical  Notices,  [Oct. 

life  remains  higher  in  England  than  in  the  rest  of  Europe.  The  industry  and 
intelligence  that  have  created  flourishing  towns,  have  ameliorated,  though  not 
so  rapidly  as  they  might  have  done,  the  sanitary  condition  of  the  people.* 

Diseases  of  different  parts  of  the  country. — The  causes  of  death  in  each  county, 
and  in  each  of  324  divisions  of  England  and  Wales,  are  given  in  a  series  of 
tables  which  have  been  framed  upon  precisely  the  same  plan  as  the  correspond- 
ing tables  in  the  last  report.  The  mortality  in  1839  by  12  classes  of  causes  is 
stated,  distinguishing  that  from  small-pox,  measles,  scarlatina,  hooping-cough, 
typhus,  and  consumption,  within  the  districts  of  the  metropolis,  Wales,  and 
nine  groups  of  counties.  The  divisions  are  arranged  in  the  order  of  their  mean 
mortality. 

Influence  of  the  Seasons. — For  the  purpose  of  ascertaining  the  exact  influence 
of  the  seasons  upon  the  duration  of  human  life,  it  is  generally  requisite  to  make 
allowances  for  the  operation  of  accidental  occurrences;  such  as  unusual  scarcity 
or  abundance,  prevalence  of  epidemics,  &c.  Mr.  Farr  informs  us,  that  he  thinks 
the  great  English  metropolis  presents  a  series  of  facts  which  enable  us  to  dis- 
pense, to  a  certain  extent,  with  such  difficult  corrections. 

"It  would,"  he  observes,  "perhaps  be  vain  to  expect  less  fluctuation  in  the 
condition  of  any  large  mass  of  people,  than  has  been  experienced  by  the  popula- 
tion of  the  metropolis  within  the  last  3  J  years,  ending  in  June,  1841:  hence,  for 
the  present  purpose,  the  mortality,  from  the  pressure  of  privation,  may  be  fairly 
considered  to  have  been  nearly  invariable  within  that  period,  and  to  have  exhi- 
bited fluctuations,  directly  or  indirectly  dependent  on  the  seasons,  if  we  except 
the  results  of  improvements  going  on  in  the  sewerage,  and  the  decline  of  the 
epidemics  of  small-pox  and  typhus." 

A  statement  is  given  of  the  deaths  registered  in  the  various  seasons  for  three 
years,  the  number  of  deaths  being  corrected  on  the  assumption  that  each  season 
of  three  months  embraced  275  days.  The  number  of  deaths  for  the  respective 
seasons  is  compared  with  the  mean  temperature  by  Fahrenheit's  scale,  and  the 
fact  of  the  increase  of  mortality  with  the  increase  of  cold,  and  its  diminution 
with  increase  of  warmth  is  strikingly  demonstrated. 


3  Winters. 

3  Springs. 

3  Summers. 

3  Autumns. 

Jan.  Feb. 

April,  May, 

July,  Aug. 

Oct.  Nov. 

March. 

June. 

Sept. 

Dec. 

39,764 

35,128 

33,677 

36,684 

Deaths, 

Temperature,  (Fahr.)  39°.8  53^.8  61^.0  44o.6 

The  causes  of  death  which  proved  the  most  fatal  in  the  cold  months  belong 
principally  to  the  pulmonary  class  and  the  cerebral  diseases  of  the  aged;  those 
which  proved  most  fatal  in  summer  belong  to  the  diseases  of  the  bowels.  The 
two  classes  of  diseases,  over  the  fatality  of  which  temperature  exercised  the 
most  marked  influence,  are  represented  with  their  respective  proportions  in  the 
following  statement: — 

Causes  of  Death. 
Diseases  of  the  Re-  "> 
spiratory  Organs.    3 
Diseases  of  the  Di- 
gestive Organs. 

Of  the  diseases  in  the  epidemic  class,  influenza  and  hooping-cough  followed 

*  The  annual  rate  of  mortality  per  cent.,  exclusive  of  still-born,  in  some  of  the  great 
European  states,  is  as  follows: — 

Years.  Per  cent. 
Prussia,                             1820—34  2,10 

France,  1817—36  2.52 

Sweden,  1810—29  2.46 

England  and  Wales,        1638—39  2.17 


Winter. 

Spring. 

Summer. 

Autumn. 

12,140 

9,890 

8,433 

11,008 

1,982 

2,139 

2,978 

2,263 

1842.] 


Registrar- GeneraVs  Third  Report. 


429 


the  same  law  as  the  pulmonary;  cholera,  dysentery,  diarrhoea  and  thrush,  as  the 
abdominal  affections.  The  mortality  from  hooping-cough  was  1674  for  the 
three  winter  months,  1208  for  spring,  644  for  summer,  and  787  for  autumn. 

From  what  has  already  been  observed,  it  is  rendered  highly  probable  that 
many  cases,  arranged  under  the  heads  of  apoplexy  and  sudden  death,  are  the 
effects  of  congestions  in  the  lungs — a  sort  of  spontaneous  asphyxia — remarks 
Mr.  Farr,  the  development  of  which  appears  to  be  favoured  by  a  temperature 
below  the  freezing  point  of  water.* 

Persons  affected  by  the  following  diseases  died  in  greatest  numbers  when  the 
temperature  was  low. 


Causes  of  Death. 

fe 

q 

1 

a 

S 

Causes  of  Death. 

tb 

Q 

S 

a 

a 

S 

a 

a 

a 

p 

q 

g 

a, 

3 
»2 

< 

a, 

3 
W 

< 

19 

Apoplexy .     .     . 

801 

627 

626 

695 

Nephritis   ?^.     .    . 

19 

17 

14 

Sudden  Death    . 

618 

524 

38J 

547 

Diabetes  .... 

19 

12!       7 

15 

Paralysis  .     .     . 

647 

520 

485 

602 

Dropsy     .... 

1403 

1286|1135 

1457 

Insanity     .     .     . 

73 

45 

35 

42 

Diseases  of  Child- 

Tetanus   .    .     . 

23 

11 

15 

19 

bed   

310 

261 

217 

309 

Asthma     .    .     . 

1733 

642 

344 

1080 

Phlegmon     .     .     . 

9 

2 

3 

1 

Bronchitis      .     . 

495 

307 

191 

347 

Ulcer 

23 

16 

9 

13 

Pneumonia    .     . 

3326 

2454 

1827 

3600 

Pleurisy    .     .     . 

70 

62 

39 

50 

Mortification    .    . 

217 

177 

153 

171 

Hydrothorax 

272 

183 

136 

206 

Old  Age  ...    . 

3437 

2609 

2150 

2814 

Disease  of  Heart 

739 

556 

571 

698 

Starvation     .    .     . 

21 

16 

7 

20 

Rheumatism .     . 

124 

113 

99 

117 

Violent  Deaths 

996 

989 

883 

924 

The  mortality  from  the  following  named  diseases  appears  but  little  affected 
by  the  range  of  temperature  of  the  seasons. 


Causes  of  Death. 

Winter. 

Spring. 

Summer, 

Autumn 

Hydrocephalus, 

1370 

1330 

1348 

1231 

Convulsions, 

2414 

2298 

2532 

2119 

Consumption, 

5600 

5778 

5501 

5148 

Scrofula, 

72 

64 

72 

54 

Cancer, 

276 

230 

264 

262 

Mr.  Farr  asks  the  questions — at  what  degree  of  cold  does  the  mortality  begin 
to  rise?  and  how  soon  after  the  cold  weather  has  set  in  are  its  effects  experienced? 
The  weekly  tables  of  mortality  furnished  by  him  afford  replies  to  these  questions. 

"Meteorologists  have  observed  that  the  mean  temperature  of  October  repre- 
sents very  nearly  the  mean  temperature  of  the  year  and  the  place;  and  the  facts 
in  the  table  show  that  the  mortality  rises  progressively,  as  the  mean  temperature 
falls  below  the  mean  temperature  of  London  (50°. 5);  the  deaths  in  the  week  ris- 
ing to  1000  and  upwards  when  the  temperature  of  night  falls  below  the  freezing 
point  of  water,  and  to  1200  when  the  mean  temperature  of  day  and  night  descends 
a  degree  or  two  lower  than  32°. 

"The  rise  in  the  mortality  is  immediate,  but  the  effects  of  the  low  tempera- 
ture go  on  accumulating,  and  continue  to  be  felt  30  or  40  days  after  the  extremi- 
ties of  the  cold  have  passed  away.     The  cold  destroys  a  certain  number  of 

*  The  rate  of  mortality  of  the  months  and  seasons  in  England  is  just  the  reverse  of 
what  it  has  been  found  to  be  in  Philadelphia,  where  the  bills  of  mortality  are  the  most 
swelled  in  the  summer  months.     See  Amer.  Journ.  Med.  Sci.  1827,  p.  129. 


430  Bibliographical  Notices,  [Oct. 

persons  rapidly,  and  in  others  occasions  diseases  whiph  prove  fatal  in  a  month 
or  six  weeks." 

The  relation  of  the  temperature  and  mortality  is  distinctly  shown  in  a 
table  given  by  Mr.  Farr,  where  accidental  irregularities  are  diminished  by 
extending  the  number  and  the  period  of  the  observations.  The  practical  les- 
son taught  by  these  facts  is,  as  Mr.  Farr  observes,  obvious.  A  great  number 
of  the  aged,  and  those  afflicted  with  difficulty  of  breathing,  whether  it  arises 
from  emphysema,  chronic  bronchitis,  diseased  heart,  or  impairment  of  the  func- 
tion of  respiration,  cannot  resist  cold  sunk  so  low  as  33°.  The  temperature  of 
the  atmosphere  in  which  they  sleep  can  never  safely  descend  lower  than  40°; 
for  if  the  cold  that  freezes  water  in  their  chamber  does  not  freeze  their  blood,  it 
impedes  respiration,  and  life  ceases  when  the  blood-heat  has  sunk  a  few  degrees 
below  the  standard.  So  far  as  statistical  investigation  has  hitherto  gone,  tem- 
perature, Mr.  Farr  thinks,  appears  to  have  no  influence  on  the  fatality  of  con- 
sumption (tubercular  phthisis);  while  it  exercises  a  well-defined  influence  in 
emphysema,  and  in  the  inflammatory  diseases  of  the  chest.  G.  E. 


Art.  XXVIII. — A  Treatise  on  the  Diseases  of  the  Heart  and  Great  Vessels,  and  on 
the  affections  which  may  he  mistaken  for  them.  Comprising  the  Author'' s  view  of 
the  Physiology  of  the  Hearfs  Action  and  Sounds,  as  demonstrated  by  his  Experi- 
ments on  the  Motions  and  Sounds  in  1830,  and  on  the  Sounds  in  1834-5.  By  J. 
Hope,  M.  D.,  F.  R.  S.,  of  St.  George's  Hospital;  formerly  Senior  Physician 
to  the  Marylebone  Infirmary;  Extraordinary  Member,  and  formerly  President, 
of  the  Royal  Medical  Society  of  Edinburgh,  &c.  First  American  from  the 
third  London  edition.  With  Notes  and  a  Detail  of  recent  Experiments.  By 
C.  VV.  Pennock,  M.  D.,  Attending  Physician  to  the  Philadelphia  Hospital, 
Blockley.     Philadelphia:  Lea  &  Blanchard,  1842:  8vo.  pp.  572,  plates  ix. 

It  is  not  a  little  gratifying  to  be  able  to  introduce  to  the  notice  of  our  readers 
an  American  edition  of  so  important  a  work  as  that  of  Dr.  Hope  on  the  diseases 
of  the  heart,  and  especially  one  enriched  as  the  present  is  by  the  valuable 
additions  of  an  editor,  whose  ardent  and  successful  devotion  to  the  investigation 
of  this  class  of  aflfections  eminently  qualifies  him  for  the  undertaking.  The 
additions  made  by  Dr.  Pennock  are  for  the  most  part  the  result  of  his^wn  per- 
sonal observation,  whilst  at  the  same  time  extracts  from  the  writings  t)f  others 
have  been  introduced  with  the  view  of  giving  a  more  accurate  account  of  exist- 
ing opinion  in  reference  to  certain  questions. 

,  In  the  chapter  on  the  anatomy  of  the  heart,  Dr.  P.  has  introduced  a  very  pre- 
cise description,  derived  from  his  own  observation,  of  the  relative  position  of 
the  various  portions  of  the  organ.  The  only  fixed  point,  he  conceives,  to  be  at 
the  valves  of  the  aorta,  whose  position  he  has  found,  by  repeated  experiments, 
■to  be  such  that  they  are  pierced  by  needles  introduced  perpendicular  to  the  plane 
of  the  sternum  through  the  middle  of  that  bone  opposite  the  middle  of  the  carti- 
lages of  the  third  ribs.  According  to  Dr.  Hope,  their  situation  is  somewhat 
lower  down. 

The  second  chapter  contains  an  account  of  those  experimental  researches  of 
the  author  upon  the  heart's  action  which  have  exerted  so  important  an  influence 
upon  the  study  of  its  pathology.  The  conclusions  thus  arrived  at  have  been  in 
the  main  confirmed  by  the  late  experiments  of  Drs.  Pennock  and  Moore,  an  ac- 
count of  which,  as  well  as  of  the  still  more  recent  ones  made  by  the  London 
committee  of  the  British  Association,  has  been  introduced  by  the  editor.  By 
the  kindness  of  Dr.  Pennock,  the  writer  of  this  had  an  opportunity  of  witness- 
ing some  of  the  experiments  instituted  by  that  gentleman,  and  was  highly  gra- 
tified with  their  satisfactory  and  decisive  results.  In  most  respects,  as  before 
mentioned,  they  are  confirmatory  of  those  of  Dr.  Hope.  Both  agree  as  regards 
the  order  of  the  heart's  movements,  the  auricular  contraction  taking  place  first, 
then  the  ventricular,  which  is  followed  by  the  period  of  repose.    This  view  of 


1842.]  '         Hoipe  on  Diseases  of  the  Heart,  ^c.  431 

the  subject  is  in  accordance  with  that  taken  by  Haller  and  the  older  physiolo- 
gists, and  its  correctness,  probably,  would  never  have  been  called  in  question, 
but  for  the  theory  of  the  sounds  of  the  heart  advocated  by  Laennec,  according 
to  whom  the  second  sound  was  occasioned  by  the  auricular  contraction,  which 
he  consequently  supposed  to  take  place  subsequently  to  that  of  the  ventricle. 
It  is  true,  that  at  the  termination  of  the  systole  of  the  ventricle,  and  correspond- 
ing with  its  diastole,  the  auricle  diminishes  somewhat  in  size,  but  that  this 
diminution  is  a  mere  passive  collapse  depending  upon  the  flow  of  blood  into  the 
dilated  ventricle  can  scarcely  admit  of  question.  Nevertheless,  this  question 
might,  perhaps,  be  placed  in  a  clearer  light  by  observing  what  takes  place 
when  the  heart  is  removed  from  the  body  and  emptied  of  its  contents.  In  fact, 
the  writer  of  this  had  an  opportunity  at  one  of  the  experiments  at  which  he  was 
present  of  observing  the  heart  under  these  circumstances  before  its  contraction 
had  ceased,  and  upon  placing  it  on  the  palm  of  the  hand,  observed  the  auricle  to 
contract  immediately  before  the  ventricular  contraction  was  felt,  after  which  no 
motion  was  observed  until  the  termination  of  the  period  of  repose.  If  fsuch 
should  be  found  to  be  the  case  in  future  experiments,  it  would  seem  to  prove  to 
demonstration  that  the  diminution  of  the  auricle  which  takes  place  subsequently 
to  the  ventricular  systole  is  altogether  passive,  since  it  disappears  after  its  cause 
is  removed  by  the  evacuation  of  the  blood,  whilst  the  active  contractions  still 
remain.  Both  series  of  experiments  above  alluded  to  are  in  accordance,  not  only 
with  reference  to  the  order  of  the  heart's  movements,  but  also  as  regards  the 
production  of  the  sounds,  the  first  being  shown  to  be  synchronous  with  the  ven- 
tricular systole,  and  independent  of  the  striking  of  the  heart  against  the  walls  of 
the  chest,  the  second  synchronous  with  the  ventricular  diastole,  and  dependent 
exclusively  upon  the  closure  of  the  semilunar  valves  by  the  reaction  of  the 
columns  of  arterial  blood  upon  them.  In  the  experiments  of  Drs.  Pennock  and 
Moore,  it  was  found  that  the  heart  was  lengthened  during  the  ventricular  con- 
traction, instead  of  the  apex  being  drawn  tovs^ards  the  base,  as  asserted  by  Hope 
and  others.  This  point  is  one  of  nice  determination,  which  will  probably  soon 
be  the  subject  of  further  investigation.  It  was  also  first  shown  by  the  American 
experimenters,  that  the  auricular  contraction  is  really  accompanied  by  a  sound 
resembling  the  ventricular,  but  short  and  more  flapping.  This  fact  is  of  practi- 
cal importance,  for  although  in  the  natural  state,  the  auricular  sound  is  inaudi- 
ble, or  lost  in  that  of  the  ventricle,  it  is  not  improbable  that  in  certain  cases  of 
disease  it  may  become  distinct,  and  thus  occasion  certain  supernumerary  sounds 
as  maintained  by  Bouillaud. 

To  the  fourth  chapter,  devoted  to  the  pathological  phenomena  of  the  heart's 
action,  several  valuable  additions  have  been  made  by  the  editor.  Thus  he 
states  that,  in  the  course  of  the  experiments  already  mentioned,  when  the  heart 
became  congested,  this  congestion  first  occurred  in  the  right  cavities,  and  was 
accompanied  with  an  extinction  of  sound  over  the  right  ventricle  and  pulmonary 
artery,  the  valvular  sound  ceasing  before  the  systolic.  In  disease,  he  says, 
similar  phenomena  are  observed,  but  the  entire  cessation  of  the  second  sound  is 
more  frequently  met  with  than  that  of  the  first.  The  position  in  which  the 
various  abnormal  valvular  murmurs  are  loudest  has  been  a  subject  of  careful  cli- 
nical research  on  the  part  of  the  editor  for  some  years  past,  and  amongst  other 
important  results,  he  tells  us  that  the  mitral  murmur  is  strongest  near  the  apex  of 
the  heart.  When  first  led  to  this  conclusion,  he  was  not  aware  of  others  hav- 
ing embraced  a  similar  view,  a  circumstance,  of  course,  calculated  to  confirm 
the  correctness  of  the  observation. 

In  the  subsequent  portion  of  the  work,  occupied  with  the  history  of  particular 
diseases,  the  editor  has  introduced  many  important  reflections,  derived  from  his 
own  ample  experience,  and  materially  enhancing  the  value  of  the  work.  He 
has  also  given  a  most  interesting  description  of  four  cases  of  dissecting  aneu- 
rism, in  which  the  lesion  is  shown  to  depend  upon  a  condition  of  parts  pre- 
viously unnoticed,  viz.,  a  separation  of  the  laminae  of  the  middle  coat  of  the 
artery. 

To  notice  more  in  detail  the  numerous  additions  of  the  editor  would  require  a 


432  Bibliographical  Notices.  [Oct. 

more  critical  examination  of  the  text  than  would  comport  with  our  present 
object.  Otherwise,  it  might  not  be  uninteresting  to  mark  the  advances 
winch  have  been  made  in  the  diagnosis  of  heart  diseases  within  the  last  ten 
years,  or  since  the  publication  of  the  first  edition  of  Dr.  Hope's  treatise  in 
the  year  1831.  In  particular,  the  distinction  of  valvular  murmurs,  the  method 
of  determining  their  seat,  as  well  as  the  precise  lesions  which  they  indicate, 
have  been  greatly  improved.  Indeed,  it  is  not  too  much  to  say,  that  in  no  de- 
partment of  practical  medicine  has  the  progress  of  improvement  been  so  great 
within  the  same  period.  For  this  we  are  largely  indebted,  as  is  well  known,  to 
the  labours  of  Dr.  Hope.  Amongst  others  who  have  contributed  to  the  same 
end,  the  name  of  Dr.  Pennock  stands  conspicuous.  Especially  are  the  thanks 
of  the  profession  in  this  country  due  to  him  for  having  put  them  in  possession 
of  so  valuable  a  treatise,  and  one  so  well  calculated  to  meet  their  wants.  We 
feel  satisfied  that  its  careful  study  will  lead  to  a  much  better  acquaintance  with 
cardiac  diseases  than  is  generally  had  amongst  us,  and  at  the  same  time  will 
convince  many  of  the  ease  and  certainty  with  which  they  may  be  distinguished 
in  a  large  majority  of  cases.  T.  S. 


Art.  XXIX. — Cours  de  Pathulogie  et  de  Therapeuiique  Gener ales, fait  a  laFacuUe 
de  Medecine  de  Paris,  par  M.  Andral;  compte-rendu  par  M.  Monneret, 
agrege  pres  cette  Faculte,  Medecin  de  bureau  central.  Gazette  Medicale  dt 
Pam,  10  Sept.  1841. 

In  our  Nos.  for  April  and  July  last,  we  gave  an  abstract  of  the  greater  por- 
tion of  the  course  of  lectures  of  M.  Andral  on  the  Physical  alterations  of  the 
Blood  and  animal  fluids  in  Disease,-  and  we  shall  now  complete  the  subject  by 
an  analysis  of  the  concluding  lecture,  which  is  devoted  to  the  consideration  of 
the  condition  of  the  blood  in  congestions  and  hemorrhages. 

In  considering  exclusively  the  composition  of  the  blood,  M.  A.  makes 
the  following  division  of  hemorrhages  and  congestions.  "  1st.  Those  in  which  the 
blood  presents  no  alteration;  2d.  Those  in  which  the  globules  alone  are  more 
numerous,  the  fibrine  being  in  its  normal  proportion.  The  alteration  here  consists 
in  a  loss  of  the  equilibrium  between  the  globules  and  the  fibrine;  3d.  Those  in 
which  there  is  a  diminution  of  the  globules.  This  occurs  only  in  cases  of 
anemia  following  plethora.  The  hemorrhage  which  was  in  the  first  place  the 
effect  of  an  excess  of  globules,  becomes  the  cause  of  their  diminution;  4th. 
Those  in  which  there  is  a  diminution  of  the  fibrine,  the  globules  being  either  in 
the  normal  state,  or  augmented  in  quantity.  The  effects  of  the  diminution  of 
fibrine,  in  the  last  case,  would  be  as  much  the  more  decided,  as  the  globules 
were  augmented.  In  a  case  of  scarlatina  accompanied  by  pulmonary  apoplexy, 
the  fibrine  fell  to  two  parts  in  a  thousand,  which  of  itself  was  of  little  moment, 
but  the  globules  were  at  the  same  time  increased  to  135.5.  5th.  In  rare  cases 
there  may  be  an  increase  of  the  fibrine;  which  occurs  in  hyperemia,  and  pre- 
disposes to  inflammation.  This  hyperemia  carries  with  it  other  consequences 
than  those  of  derangement  of  the  circulation.  In  it  are  the  elements  of  the  ter- 
minations of  inflammation,  as  suppuration,  ulceration  and  softening. 

"  Hemorrhages  and  congestions  may  be  local  or  general,  according  as  they 
depend  upon  a  local  cause,  or  upon  one  pervading  the  system.  It  is  necessary 
to  seek  the  cause  of  local  hemorrhage  in  the  living  solids.  This  cause  may  be 
some  obstacle  to  the  circulation,  which  impedes  the  return  of  the  blood  from  the 
branches  to  the  trunks,  as  in  certain  diseases  of  the  heart;  or  the  hemorrhage 
may  be  produced  by  a  local  stimulant,  as  when  a  foreign  body  penetrates  into 
the  conjunctiva,  causing  an  effusion  of  blood,  which,  in  this  case,  is  not  at  all 
altered  in  composition.  Inflammation  may  be  conceived  to  give  rise  to  hemor- 
rhage in  a  manner  purely  mechanical,  by  causing  an  obstacle  to  the  course  of 
the  blood,  or  by  increasing  the  rapidity  of  the  circulation,  or  in  some  other  man- 
ner.    Finally,  it  is  not  always  easy  to  determine  whether  a  hemorrhage  be  from 


t 


1842.]  Andral  on  the  Physical  Alterations  of  the  Blood.  433 

a  local  or  general  cause;  it  often  appears  to  result  from  a  local  cause  when  a  more 
attentive  examination  would  show  that  it  depended  on  an  alteration  of  the  hlood 
— certain  obstinate  hemorrhages  cannot  be  arrested  solely  by  local  treatment,  but 
they  continually  recur  until  we  direct  an  active  treatment  to  the  general  system. 

"Constitutional  hemorrhages  now  and  then  deceive  us,  being  taken  for  purely 
local  accidents,  until  their  breaking  out  anew  from  many  different  parts  prove 
their  origin  to  have  been  very  different.  These  remarks  apply  also  to  conges- 
tions. It  is  a  serious  error  to  treat  them  all  by  local  means.  Some,  being  the 
effect  of  an  alteration  of  the  blood,  cease  only  under  the  influence  of  general 
treatment;  others,  require  local  treatment  directed  to  the  alterations  of  the  solids 
giving  rise  to  them.  It  is,  then,  only  by  an  accurate  knowledge  of  the  true 
causes  of  congestions  that  we  can  establish  their  therapeutics;  and  if  we  find  in 
ancient  and  modern  authors  so  much  hesitation,  obscurity  and  error,  it  is  be- 
cause they  were  ignorant  of  the  changes  of  the  blood  which  caused  these  affec- 
tions, and  were  thereby  constrained  to  confine  themselves  to  the  observation  of  ex- 
ternal signs,  which  afford  but  an  indefinite  idea  of  these  alterations. 

"Plethora  is  a  very  common  cause  of  hemorrhage  and  congestion,  and  these 
occur,  though  more  rarely,  in  anemia.  There  is  an  augmentation  of  the  globules 
in  the  first  case,  and  a  diminution  in  the  second.  Hemorrhages  and  congestions, 
I  have  remarked,  are  rare  in  chlorosis,  nevertheless  they  do  sometimes  occur  in 
this  malady,  as  well  as  in  all  morbid  states  when  there  exists  a  general  atony 
of  the  system,  causing  a  great  difficulty  in  the  circulation,  and  preventing  the 
blood  from  easily  traversing  the  capillaries.  Observation  teaches  us  that  if  we 
give  iron  to  women  whose  catamenia  are  too  profuse,  and  who  are  feeble,  pale 
and  anemic  in  consequence  of  this  immoderate  menstrual  flux,  we  shall  restore 
their  strength,  and  diminish,  without  stopping,  the  menstrual  flow.  These  cases 
exhibit  the  active  and  passive  varieties  of  hemorrhage  combined.  At  the  com- 
mencement there  was  plethora,  or  in  other  words  an  augmentation  of  the  glo- 
bules, which  caused  the  hemorrhage,  or  at  least  rendered  the  flow  abundant,  in  a 
short  time  this  becomes  passive,  with  signs  of  debility,  when  the  plethora  and 
augmentation  of  the  globules  are  succeeded  by  anemia  and  a  diminution  of  the 
globules.  Here,  then,  are  two  conditions  of  the  system  entirely  opposite,  which 
mutually  succeed  and  produce  each  other.  Before  the  special  alterations  which 
the  blood  underwent  in  these  two  cases  was  known,  it  was  difficult  to  determine 
the  mode  of  production,  and  the  true  cause  of  these  hemorrhages.  1  do  not  say 
that  they  escaped  the  notice  of  the  ancients;  their  division  of  hemorrhages  into 
active  and  passive,  is  a  witness  of  their  great  talent  for  observation;  a  talent 
which  some  narrow-minded  spirits  allow  to  modern  authors  alone. 

"  Congestions  and  hemorrhages  which  result  from  a  diminution  of  the  fibrine, 
are  seen  in  those  persons  whose  blood  coagulates  with  difficulty,  and  which 
forms  a  clot  with  little  or  no  buff.  The  physical  properties  of  such  blood  coin- 
cides with  those  which  chemical  analysis  makes  known  to  us.  Hemorrhages 
which  arise  from  such  a  cause  appear  in  fevers  accompanied  with  a  diminution 
of  the  fibrine  of  the  blood,  in  scorbutic  affections,  in  typhoid  fever,  and  espe- 
cially in  the  great  typhus  epidemics,  in  the  plague  and  in  yellow  fever." 

With  the  preceding  facts,  M.  A.  conceives  that  we  can  "determine  whether 
the  divisions  of  active  and  passive  hemorrhages,  employed  in  former  times,  have 
a  real  value  when  examined  in  connection  with  the  alterations  of  the  blood." — 
"Active  congestions,"  he  says,  "and  hemorrhages  may  be  caused  by  some  stimu- 
lant, a  point  of  irritation  fixed  in  the  tissues,  or  by  an  alteration  of  the  blood 
which  consists  in  an  augmentation  of  its  globules.  An  over  activity  of  the 
functions,  or  of  the  vitality  of  all  the  tissues,  tends  to  increase  the  globules; 
thus,  plethoric  persons  are  liable  to  hemorrhages  called  active.  Passive  hemor- 
rhages and  congestions,  like  the  active,  have  a  point  of  departure  both  in  the 
solids  and  in  the  blood.  Those  pulmonary  congestions  which  so  frequently 
occur  in  the  last  moments  of  life,  as  the  sequel  of  diseases  which  produce 
a  gradual  prostration  of  the  whole  organism,  are  often  caused  solely  by  a 
diminution  of  the  vital  properties  of  the  tissues.  It  is  not  then  at  all  strange 
that  the  fluids,  especially  the  blood,  do  not  flow  in  the  capillaries  with  their  ordi- 
No.  VIll.— October,  1842.  37 


434  Bibliographical  Notices,  [Oct. 

nary  regularity,  and  that  they  either  escape  from  their  natural  channels,  or  stag- 
nate in  the  organs.  It  is  necessary  to  distinguish  with  care  these  congestions, 
from  others,  equally  passive,  which  result  from  an  alteration  of  the  qualities  of 
the  blood;  as,  for  instance,  the  congestions  of  malignant  fevers.  The  ancients, 
who  turned  their  whole  attention  to  the  condition  of  the  blood  in  these  fevers, 
designated  this  alteration  under  the  name  of  the  dissolution  of  the  blood." 

No  physician  of  former  times  studied  the  blood  with  greater  care  than  the 
celebrated  Huxham,  and  M.  Andral  therefore  presents  a  summary  of  his  doc- 
trines, and  compares  his  researches  with  those  recently  instituted  relative  to  the 
changes  of  the  vital  fluid. 

"Huxham,"  he  remarks,  "commences  the  study  of  fevers  by  the  history  of 
the  simple  fever  which  is  produced  solely  by  an  augmentation  of  the  action 
of  the  solids  upon  the  liquids,  and  of  the  reaction  of  these  latter  upon  the 
former.  He  supposes  three  cases  in  which  the  cause  acts  in  this  manner.  First, 
Where  a  person  of  a  good  constitution  exercises  violently,  thereby  causing  in 
himself  an  energetic  reciprocal  action  of  the  solids  and  fluids  upon  each  other. 
Second,  Where  a  person,  in  a  free  perspiration,  suddenly  exposes  himself  to 
cold,  augmenting,  by  this  means,  the  quantity  of  fluids  in  his  system.  In 
this  case,  nature  labours  to  expel  the  superabundant  fluids.  The  third  case,  is 
that  of  a  person  who  drinks  a  very  large  quantity  of  wine  or  of  spirituous  liquors, 
producing,  by  this  means,  a  simple  fever,  which  soon  yields  to  abstinence  and 
repose.  But  sometimes  the  blood  is  too  strongly  agitated,  and  the  red  globules 
penetrate  into  capillaries  which  do  not  habitually  receive  them.  Thence  the 
obstructions  so  frequent  in  fevers.  The  treatment  which  appeared  to  Huxham 
to  merit  the  preference  over  all  others  was  blood-letting,  which,  diminished  the 
quantity  of  the  red  globules,  and  weakened  the  moving  force.  The  idea  that 
bleeding  diminished  the  globules  is  perfectly  true;  and  it  is  curious  to  see  that 
the  recent  analysis  of  the  blood  is  in  entire  accordance  with  the  foresight  of 
Huxham;  I  say  foresight,  for  he  not  being  able  to  rest  his  opinions  upon 
analysis,  was  induced  to  advance  them  upon  views  purely  theoretical.  I  have 
already  frequently  said,  that  there  was  an  augmentation  of  the  red  globules  in 
plethora,  and  that  bleeding  was  the  best  remedy  for  this  state  of  the  blood,  since 
it  acted  especially  upon  the  globules,  by  diminishing  them,  and  but  slowly 
aflfected  the  fibrine.  At  the  time  Huxham  wrote,  the  analysis  of  the  blood  was 
very  incomplete,  and  the  true  composition  of  this  fluid  but  imperfectly  known; 
but,  on  the  contrary,  the  medical  world,  struck  with  the  discovery  of  globules 
in  the  blood  made  by  the  celebrated  Leuenhoeck,  were  then  much  engrossed 
with  the  microscopic  examination  of  the  fluids;  thus  all  the  theories  upon  ob- 
struction, upon  an  'error  loci,'  and  upon  the  diflferent  orders  of  vessels  and  of 
globules  sprung  up  at  this  period. 

"Huxham  followed,  as  did  every  one  else,  the  prevailing  ideas  of  his  time. 
He  admitted  three  leading  alterations  of  the  blood.  The  two  first  he  called  the 
constitutional  states  of  the  blood;  the  third  was  the  state  of  dissolution  and 
putrefaction.  The  first  morbid  modification  was  that  in  which  the  globules 
were  augmented,  being  pressed  against  each  other  too  compactly;  whence  re- 
sulted, according  to  our  author,  a  disposition  in  the  blood  to  coagulate  as  soon 
as  it  was  drawn  from  the  vein.  He  said  he  had  particularly  observed  this  state 
of  the  blood  in  persons  of  a  robust  constitution,  who  exercise  much  and  live 
well.  He  supposes  that  the  vessels  are  very  strong  and  elastic;  that  they  con- 
vey the  fluids  with  energy;  that  the  friction  of  the  particles  of  the  blood  is  greater 
than  in  the  normal  state;  that,  in  fine,  more  heat  is  produced.  The  most  fluid 
parts  of  the  blood  pass  into  a  state  of  vapour,  and  the  remainder  then  becomes 
very  viscid,  which  causes  an  impermeability  of  the  capillaries,  and  consequent- 
ly, obstructions  to  the  circulation.  He  attributes  the  thick  and  gelatinous  crust, 
which  we  call  the  pleuritic  buff",  to  the  heat  of  the  fever,  which  tends  to  coagu- 
late the  serous  parts  of  the  blood,  and  to  convert  it  into  a  jelly.  All  this  theory, 
formed  by  Huxham  with  so  much  ingenuity,  vanishes  before  recent  analyses  of 
the  blood.  We  are  yet  ignorant,  notwithstanding  the  most  close  and  muliij)lied 
microscopical  researches,  of  the  alterations  of  the  globules.     The  influence 


1842.]         Andral  on  the  Physical  Alterations  of  the  Blood.  435 

ascribed  to  the  friction  of  the  corpuscules,  and  the  rapidity  of  their  circulation 
in  the  production  of  fever,  is  an  idea  too  mechanical  and  imaginative  to  receive 
any  attention.  Hemorrhages  are  explained,  according  to  the  theory  of  Hux- 
ham,  by  a  rupture  of  the  small  vessels  caused  by  the  globules. 

"The  second  morbid  constitution  of  the  blood  is  characterized  by  a  diminu- 
tion of  the  red  globules  whose  texture  becomes  soft,  and  by  an  excess  of  its 
watery  portion.  The  symptoms  which  arise  from  this  state  of  the  globules,  are 
pallor,  debility,  imperfect  secretion  and  dropsies.  Obstructions  immediately 
follow,  which  are  not  of  an  inflammatory  nature,  as  they  were  in  the  first  alter- 
ation of  the  blood  just  noticed,  but  from  a  want  of  sufficient  excitement  of  the 
capillaries  and  vessels,  and  these,  therefore,  allow  the  blood  to  stagnate  in  them. 
Passive  congestions  are  formed  in  this  manner.  The  diminution  of  the  globules 
which  Huxham  admitted  upon  hypothesis,  is  at  this  day  demonstrated  by  the 
analyses  which  have  been  already  given.  We  observe  this  diminution  in 
anemia,  chlorosis,  and  in  those  cachexies  which  follow  chronic  diseases. 

"The  third  morbid  state  of  the  blood  is  seen  in  scurvy,  which  may  be  con- 
sidered as  a  type  of  this  alteration.  Hemorrhage  and  debility  are  the  principal 
symptoms.  The  clot  is  a  soft  mass,  jelly-like,  and  without  any  buff,  and  the 
serum  separates  very  incompletely  from  it;  blood  taken  from  persons  affected 
with  petechiae  and  ecchymoses,  offers  an  uniform  mass,  half  coagulated,  of  a 
livid  or  deeper  colour  than  usual,  and  very  quickly  putrefies.  Huxham  believed 
that  the  hemorrhages  most  commonly  arose  from  an  acridity  of  the  humours 
which  destroyed  the  texture  of  the  blood,  and  corroded  the  extremities  of  the 
arterial  capillaries.  He  did  not  hesitate  even  to  attribute  them  to  the  too  feeble 
constitution  of  the  red  globules,  which  were  not  sufficiently  condensed  by  the 
action  of  the  heart  and  arteries,  and  escaped  by  lengthening  themselves  or  split- 
ting into  pieces.  He  says  that  in  examining  the  blood  in  the  capillaries,  we  see 
the  globules  elongating  themselves  in  order  to  traverse  the  small  vessels;  and  he 
admits  upon  hypothesis,  that  they  could  divide  into  pieces  in  their  passage,  and 
then  these  pieces  easily  entering  into  the  excretory  channels,  transude  by  diape- 
desis,  as  we  see  in  the  intestinal  and  urinary  hemorrhages.  The  petecliiae  and 
ecchymoses  prove  also  that  the  red  globules  may  be  dissolved  and  broken  up, 
and  that  they  enter  into  the  serous  and  exhalant  vessels,  where,  being  arrested, 
they  produce  spots.  The  petechias  of  malignant  fevers,  the  fuliginous  sweats, 
a^d  the  black  urine,  with  a  livid  sediment,  (a  matter  similar  to  coffee,  which  we 
meet  with  in  certain  varieties  of  urine),  are  formed  from  the  blood,  and  are  due 
to  the  dissolved  state  of  this  fluid.  The  dissolution  of  the  blood  manifests  itself 
in  a  feeble  degree  in  these  cases,  as  for  example,  in  women  whose  menses  are 
immoderate.  This  condition  of  the  blood  is  as  yet  compatible  with  health,  but 
if  it  be  carried  a  step  farther,  it  marks  a  malady,  the  principal  symptoms  of 
which  are  hemorrhage  and  debility.  This  dissolution  of  the  blood  is  seen  but 
in  one  other  disease.  We  see,  for  instance,  cases  of  pneumonia  when  the  blood 
does  not  yield  a  huffy  coat.  Huxham  speaks  of  an  epidemic,  in  which  pneumo- 
nia was  accompanied  with  petechise  and  hemorrhages,  besides  its  proper  symp- 
toms. He  designated  it  under  the  name  of  the  epidemic  peripneumonic  fever; 
it  attacked  prisoners  and  sailors  when  congregated  in  large  numbers;  and  the 
blood  taken  from  them  had  little  or  no  consistence,  while  that  taken  from  per- 
sons afflicted  with  open  pneumonia  was  dense,  consistent,  and  covered  with  a 
thick  crust. 

"The  causes  of  the  dissolution  of  the  blood  are  some  of  them  entirely  sponta- 
neous, and  others  the  effect  of  certain  poisonous  agents  entering  the  system. 
Huxham  classed  under  the  latter  head  the  alkaline  salts,  hydrochlorate  of  ammo- 
nia which  dissolves  or  destroys  the  blood  in  a  few  minutes,  the  water  of  the 
cherry  laurel,  the  bite  of  the  serpent  Hemorrhous,  mercury,  and  salted  and  half 
putrid  provisions.  He  believed  that  this  last  cause  determined  the  petechial 
fevers,  dysenteries,  hemorrhages,  and  scurvy  which  were  formerly  so  frequently 
seen  on  board  of  ships  among  the  sailors  who  had  lived  a  long  time  on  salted 
food,  and  which  sometimes  was  also  half  decayed.  The  study  of  the  nlterations 
of  the  blood  leads  us  to  believe,  that  in  all  the  above  cases,  there  was  no  dimi- 


436  Bibliographical  Notices,  [Oct. 

nution  of  the  fibrine  in  proportion  to  the  globules.  An  absolute  and  prolonged 
privation  of  food  might  cause  these  same  effects,  but  the  ordinary  and  most  fre- 
quent result  of  such  a  cause  would  be  anemia.  An  elevated  temperature  has 
been  considered  as  a  cause  capable  of  producing  a  dissolution  of  the  blood. 
Boerhaave  speaks  in  his  chemistry  of  an  experiment  which  was  made  upon  a 
dog.  He  was  shut  up  in  the  stove  of  a  sugar  refinery,  and  as  the  svt'eat  became 
quite  abundant,  hemorrhages  from  different  parts  commenced,  which  seemed  to 
the  author  to  be  caused  by  a  dissolution  of  the  blood.  He  thinks  that  the  ele- 
vated temperature  of  certain  countries  acts  in  the  same  manner,  although  with 
less  power,  and  that  it  is  capable  of  giving  rise  to  diseases  of  a  peculiar  charac- 
ter. Huxham  taking  into  consideration  the  experiment  of  Boerhaave,  sees  in 
it  an  irrefragable  proof  of  the  deleterious  influence  exercised  by  an  elevated 
temperature;  but  it  requires  more  precise  experiments  to  place  this  supposition 
beyond  a  doubt.  We  can  affirm  with  all  observers,  ancient  and  modern,  that 
fevers  with  symptoms  announcing  a  dissolution  of  the  blood  are  very  common  in 
hot  climates;  the  precise  alteration  merits  all  the  attention  of  the  practitioner,  and 
claims  an  especial  treatment,  which  has  been  admirably  traced  out  by  the  ancients. 
"Among  the  causes  which  reduce  the  fibrine  we  ought  to  class  the  infectious 
and  contagious  miasms.  Huxham,  who  described  ihem,  does  not  give  them 
their  necessary  influence  on  the  dissolution  of  the  blood.  This  fluid  must 
first  be  modified  in  a  certain  manner  before  receiving  their  influence:  it  is  this 
which  explains  the  difference  of  the  symptoms  which  are  sometimes  inflamma- 
tory, and  again  typhoid  and  ataxic. 

"There  is  another  series  of  agents  which  have  their  origin  in  the  system, 
among  wliich  are  pus,  and  blood  and  flesh  in  a  state  of  putrefaction.  Gaspard 
instituted  a  number  of  experiments  for  the  purpose  of  demonstrating  the  delete- 
rious influence  exercised  by  septic  liquids  on  the  whole  system,  and  these  have 
been  often  repeated,  and  also  confirmed  by  pathological  facts.  The  greater  por- 
tion of  the  poisonous  agents  which  we  have  mentioned,  are  at  this  time  con- 
sidered capable  of  causing  a  great  modification  in  the  composition  of  the 
blood;  they  act  particularly  by  changing  the  relations  of  the  globules  to  the 
fibrine,  either  diminishing  the  fibrine,  or  it  may  be  absolutely  augmenting  the 
globules.  If  we  strike  from  the  work  of  Huxham  all  hypothesis,  we  are  yet 
surprised  to  find  a  mass  of  curious  facts  which,  so  far  from  having  been  over- 
thrown by  chemical  inquiries,  are  confirmed  by  them.  I  ought  to  remark,  that 
Huxham  was  led  to  these  truths,  which  are  now  placed  beyond  a  doubt,  by  the 
aid  of  reasoning  and  hypothesis  alone." 

Blood  in  the  Fluxes. — When  a  large  quantity  of  organic  materials  escape  from 
the  system  the  blood  is  impoverished.  A  flux  M.  A.  regards  as  a  dropsy,  the 
fluid  of  which  instead  of  being  retained  in  a  cavity,  escapes  outwards.  What 
is  said,  therefore,  of  dropsies  may  be  applied  to  the  fluxes. 

"  There  are  a  certain  number  of  dropsies,"  M.  A.  observes,  "  which  are  entirely 
independent  of  the  condition  of  the  blood;  such  are  those  produced  by  an  ob- 
stacle to  the  circulation,  or  by  inflammation.  There  are  others  which  have  been 
generally  considered  as  an  effect  of  an  impoyerishment  of  the  blood,  which  is 
then  supposed  to  contain  a  greater  proportion  of  water  than  in  the  normal  state. 
We  have  admitted,  from  observation  of  the  symptoms,  of  a  dropsy  from  ple- 
thora, and  another  from  anemia.  In  the  first,  all  the  elements  of  the  blood  are 
augmented,  particularly  the  globules.  The  number  of  cases  of  dropsy  from  ple- 
thora have  been  exaggerated,  and  many  of  those  cited  were  probably  complex 
cases  where  the  diagnosis  was  not  well  made  out. 

"Without  entirely  rejecting  the  existence  of  dropsies  due  to  this  cause,  we 
ought  to  be  very  cautious  upon  the  subject,  and  give  our  attention  only  to  facts 
recently  collected  by  men  who  have  been  in  the  habit  of  carefully  observing  the 
condition  of  the  organs,  and  especially  of  those  charged  with  the  secretion  of 
urine." 

M.  Andral  asks  whether  we  find  dropsies  caused  by  anemia?  In  reply  he 
states,  that  it  is  necessary  to  distinguish  many  kinds  of  anemia.  "1st.  The 
ordinary  anemia,  where  there  is  simply  a  diminution  of  the  globules.     2d.  Ad- 


1842.]         Andral  on  the  Physical  Alterations  of  the  Blood.  437 

yanced  anemia,  in  which  the  fibrine  and  globules  are  equally  diminished.  In 
chlorosis,  which  is  an  anemia  of  the  first  class,  dropsy  is  of  very  rare  occur- 
rence whatever  may  be  the  extent  of  the  malady;  in  those  cases  even  where  the 
reduction  of  the  globules  is  very  great,  where,  for  example,  they  are  reduced  to 
twenty-seven.  In  some  patients  the  lower  parts  of  the  limbs  around  the  malleoli 
pit  upon  pressure,  and  offer  a  very  slight  degree  of  oedema;  in  others  there  is 
a  puffiness  of  the  countenance  and  swelling  of  the  eyelids,  but  we  never  meet 
with  dropsy,  which  proves  that  the  reduction  of  the  globules  alone  is  not  sufficient 
to  explain  the  production  of  that  disease.  In  the  anemic  conditions  which  occur 
in  men,  dropsy  is  as  rare  as  it  is  in  women.  Simple  pulmonary  phthisis,  and 
organic  diseases  of  the  stomach  cause  a  diminution  of  the  globules,  but  not 
dropsy,  and  whenever  these  show  themselves,  we  ought  to  seek  the  cause  else- 
where than  in  the  primary  organic  affection.  It  is  rare  in  these  cases,  not  to  find 
some  of  those  lesions,  the  ordinary  effect  of  which  is  an  effusion  of  serum. 

*' I  had  recently  an  opportunity  of  verifying  this  truth  in  a  sick  person  lying  in 
one  of  the  halls  of  La  Charite;  he  had  pulmonary  tubercles,  and  presented  besides 
a  considerable  infiltration  of  the  lower  extremities  and  of  the  skin  of  the  abdo- 
men. 1  did  not  hesitate  to  declare  that  the  great  alterations  existing  in  the  lungs 
were  not  the  cause  of  the  oedema,  and  an  examination  of  the  urine  showed  that 
the  kidneys  were  also  diseased. 

"Dropsy  exists  where  it  is  difficult  to  arrive  at  a  precise  determination  of 
its  cause.  We  see  it  in  subjects  afflicted  with  uterine  cancer,  accompanied 
with  metrorrhagia,  and  in  infants  subject  to  hemorrhage:  undoubtedly  these 
losses  of  blood  cause  a  diminution  of  the  globules  and  of  the  other  constituents 
of  the  blood;  but  1  repeat,  this  alteration  of  the  blood  does  not  suffice  to  explain 
the  cause  of  the  dropsy,  since  this  affection  is  rare  in  chlorosis  where  there  is 
such  a  marked  diminution  of  the  globules; — but  we  might  here  allege  that  the 
dropsy  was  the  effect  of  the  rapid  loss  of  the  globules,  or  from  the  rapid  dimi- 
nution of  the  albumen;  for  these  sudden  changes  in  the  qualities  of  the  blood  do 
not  take  place  in  chlorosis.  I  believe  it  is  necessary  to  declare  that  this  subject 
is  still  surrounded  with  too  much  obscurity  for  any  one  to  give  a  positive  opin- 
ion upon  the  cause  of  these  dropsies. 

"  In  certain  cases  where  the  food  is  insufficient  and  of  poor  quality,  as  in 
times  of  famine,  it  is  not  uncommon  to  meet  with  dropsies.  M.  Gaspard  observed 
this  among  the  inhabitants  of  a  country,  who,  during  a  frightful  famine,  were 
obliged  to  live,  like  the  beasts  of  the  field,  upon  plants  and  such  roots  as  they  could 
get.  We  may  be  sure  that  the  alteration  of  the  blood  here  consisted  in  some- 
thing else  than  the  diminution  of  the  globules,  otherwise  they  would  have  been 
chlorotic  instead  of  dropsical. 

"Dropsies  form  when  a  large  quantity  of  albumen  escapes  by  the  kidneys. 
There  is  here  existing  at  once,  a  diminution  of  the  globules,  and  a  discharge  of 
a  large  proportion  of  albumen.  We  might  be  tempted  to  attribute  the  serous 
effusion  to  the  latter  modification  of  the  blood,  since,  as  I  have  said,  the  former 
is  insufficient  to  produce  it;  but  I  repeat,  nothing  is  fixed  in  regard  to  it.  In  a 
disease  so  complex  as  the  albuminous  disease  of  the  kidney,  which  is  not  a  sim- 
ple nephritis,  as  some  authors  have  imagined,  there  is  certainly  something  else 
besides  the  pathological  alteration  of  the  kidney;  the  blood  is  altered,  but  we 
know  not  with  certainty  either  in  what  manner  it  is  produced,  or  what  influence 
it  exerts  in  the  production  of  the  disease. 

"There  are  dropsies,  the  seat  of  which  it  is  necessary  to  seek  in  the  solids. 
It  is  common  enough  in  equatorial  countries  to  see  dropsies  in  persons  who 
have  been  exposed  to  the  cold  of  night.  We  cannot  affirm  that  these  are  ana- 
logous to  the  disease  of  Bright,  because  it  would  first  be  necessary  that  an  exa- 
mination of  the  urine  had  been  made  by  physicians  who  had  witnessed  this 
disease.  We  can  only  assert  that  cold  is  one  of  the  remote  causes  of  this  affec- 
lion." 

"  7'o  recapitulate.  A  diminution  of  the  globules  of  the  blood,  to  whatever 
extent  it  may  occur,  if  it  takes  place  slowly,  will  not  produce  dropsy.  If  the 
diminution  be  effected  rapidly,  dropsy  may  supervene,  but  we  can  only  say  that 

37* 


438  Bibliographical  Notices.  [Oct. 

it  is  then  a  coincidence,  without  being-  able  to  go  farther.  If  we  admit  that  a 
diminution  of  the  solid  materials  of  the  serum,  especially  the  albumen,  is  a  cause 
of  certain  dropsies,  we  might  bring  together  the  following  facts.  1.  The  serum 
from  blisters  contains  less  albumen  than  the  serum  of  the  blood.  2.  M.  Dutro- 
chet  has  proved  that  in  the  phenomena  of  endosmose,  it  is  the  least  dense  liquid 
which  enters  the  densest  liquid  enclosed  in  the  membranous  bag.  We  might  then 
ask,  if  a  diminution  of  the  albumen  in  the  blood  of  persons  with  Bright's  disease, 
allows  the  serum  to  transude  more  easily  into  the  cellular  tissue,  ought  not  the 
same  result  to  follow  in  other  cases  where  we  find  this  impoverishment.  We  re- 
mark, in  closing,  that  the  term  impoverishment  of  the  blood,  is  vague  when  we 
attempt  to  apply  it  to  dropsies,  since  they  do  not  exist  in  chlorosis  where  there  is 
so  considerable  a  diminution  of  the  globules,  and  impoverishment  of  the  blood." 

Next  follow  some  remarks  relative  to  the  accidental  products  contained  in  the 
Wood.  "Tubercle,  scirrhus,  and  encephaloid  matter,"  he  observes,  "are  not 
simply  products  of  disease  of  the  solids.  They  are  very  probably  connected 
with  a  more  general  state  of  the  system  in  which  the  different  fluids  of  the 
economy  participate.  We  designate  this  general  state  by  the  word  diathesis, 
which  means  that  the  disease  consisis  in  a  modification  of  which  we  know 
nothing.  Another  modification  consecutive  to  the  first  is  cachexia;  it  is  a  more 
decided  morbid  modification,  and  results  from  the  preceding.  Men  have 
always  sought  the  causes  of  the  various  diatheses  in  the  blood,  and  the  ancients 
were  not  backward  in  their  expositions;  but  we  now  prefer  to  avow  our  igno- 
rance when  it  is  upon  the  nature  of  the  humoral  alterations.  It  would  first  be 
necessary  to  ascertain  whether  the  diathesis  consisted  in  a  modification  of  this 
or  that  element  of  the  blood,  and  what  relation  there  was  between  this  modifica- 
tion and  the  morbid  product.  Are  the  constituents  of  the  blood  augmented,  or 
diminished,  or  altered  in  their  qualities'?  In  the  calcareous  diathesis,  for  in- 
stance, it  would  be  necessary  to  examine  whether  there  is  not  some  modifica- 
tion in  the  inorganic  materials  of  the  serum;  in  rachitis,  whether  there  is  a  dimi- 
nution of  the  phosphate  of  lime,  &c.  All  these  points,  which  belong  to  the 
highest  questions  of  pathogeny,  cannot  be  well  treated  upon  without  possessing 
still  more  precise  analyses  of  the  blood." 

"The  last  class  of  diseases  in  which  we  have  to  examine  the  condition  of  the 
blood  are  the  neuroses.  We  might  say  at  first,  in  a  general  manner,  that  this 
fluid  offered  no  appreciable  change.  There  are  great  differences  in  the  constitu- 
tions of  persons  afflicted  with  the  neuroses.  It  is  rare  that  we  see  them  in  per- 
sons of  a  strong  and  plethoric  constitution,  and  we  are  thence  led  to  believe 
that  an  augmentation  of  the  globules  is  incompatible  with  them;  the  dimi- 
nution of  the  globules,  on  the  contrary,  seems  to  favour  them.  A  fee- 
ble muscular  development,  pallor,  an  anemic  constitution  often  coincide  with 
them,  and  when  these  all  exist  in  a  subject,  the  nervous  affection  is  the  more 
severe.  Can  we  conclude  from  this  that  the  diminution  of  the  globules,  which 
constitutes  the  alterations  of  the  blood  indifferent  physiological  and  pathological 
states,  has  any  relation  to  the  existing  neuroses'?  This  conclusion  would  be 
premature,  for  there  are  affections  where  the  diminution  of  the  globules  is 
marked,  and  yet  no  neuroses  manifest  themselves.  Nervous  subjects  have  often 
all  the  appearances  of  plethora,  but  an  analysis  of  their  blood  shows  a  diminu- 
tion of  the  globules;  it  is  a  false  plethora,  which  it  is  necessary  to  understand, 
for  it  leads  us  to  bleed,  when  bleeding  would  be  badly  borne.  Finally,  in  these 
nervous  affections,  the  diminution  of  the  globules  is  never  so  great  as  in  anemia." 

We  have  now  completed  an  account  of  the  important  researches  of  MM. 
Andral  and  Gavaret,  and  of  the  numerous  deductions  drawn  from  them  by  M. 
Andral,  and  invite  particular  attention  to  them,  as  they  are  capable  of  many 
useful,  applications  to  pathology,  and  of  valuable  practical  applications. 


1842.]  Druitl's  Modern  Surgery.  439 


Art.  XXX. — The  Principles  and  Practice  of  Modern  Surgery.  By  Robert 
Druitt.  "  Id  potissimum  agens,  ut  omissis  hypotliesibus,  in  praxi  nihil 
adstruat  quod  multiplici  experientia  non  sit  roboratLim." — Act.  Erud.  Lips. 
1722.  From  the  second  London  edition,  illustrated  with  fifty  wood  engrav- 
ings; with  Notes  and  Comments.  By  Joshua  B.  Flint,  M.D. — MM.  SS., 
Lecturer  on  Therapeutic  and  Operative  Surgery  in  the  Louisville  Academy  of 
Medicine,  and  late  Professor  of  Surgery  in  the  Medical  Institute  of  LouiS" 
ville.     Philadelphia:  Lea  and  Blanchard,  1842;  8vo.  pp.  534. 

The  design  of  this  work,  as  stated  by  the  author  in  his  preface,  is  "  to  afford 
a  short  but  complete  account  of  modern  surgery,  to  contain  every  thing  that  is 
essential  to  the  right  understanding  of  its  principles,  and  to  embody  the  expe- 
rience of  the  highest  authorities  as  to  the  best  rules  of  practice."  It  is  divided 
into  five  parts,  the  first  two  more  especially  devoted  to  the  principles,  and  the 
three  others  to  the  practice  of  Surgery.  The  first  part  treats  of  the  disturbances 
of  the  constitution  at  large,  that  may  be  produced  by  injury  or  disease  of  a 
part;  beginning  with  the  simple  faintness  or  collapse  that  follows  a  blow, 
and  proceeding  to  the  varieties  of  fever  and  tetanus.  The  second  part  describes 
what  may  be  called  the  elements  of  local  disease;  that  is  to  say,  those  morbid 
changes  of  structure  or  functions  which  are  produced  either  immediately  by  ex- 
ternal causes,  or  secondarily,  through  some  deviation  from  health;  including  not 
only  the  common  changes  of  structure  which  may  be  produced,  almost  at  will,  in 
any  constitution;  but  those  diseases  also,  such  as  cancer  and  scrofula,  which  re- 
quire some  peculiarity  of  the  system  for  their  development,  and  which  are  con- 
sequently termed  specific.  The  third  part  treats  of  the  various  kinds  of  injuries, 
beginning  with  the  simplest  mechanical  injuries;  then  proceeding  to  the  effects 
of  chemical  agents,  and  lastly,  considering  the  effects  of  morbid  poisons.  The 
fourth  part  considers  the  various  tissues,  organs,  and  regions  of  the  body  in 
order,  and  describes  the  various  accidents  they  are  liable  to,  and  such  of  their 
diseases  as  are  commonly  assigned  to  the  care  of  the  surgeon.  The  fifth  part 
describes  such  of  the  operations  as  are  not  included  in  the  former  parts.  The 
work  is  illustrated  by  a  number  of  extremely  well  executed  wood  cuts. 

Considering  the  very  enlarged  scope  of  this  work,  it  is  almost  marvellous  that 
the  author  should  have  been  able  to  accomplish  his  task  in  a  satisfactory  man- 
ner, within  the  narrow  limits,  as  to  space,  to  which  he  has  restricted  himself. 
He  has  nevertheless  done  so,  and  in  a  way  to  command  the  approval  of  all  the 
medical  journalists  of  Great  Britain,  and  with  scarcely  an  exception,  those  of 
this  country. 

As  a  manual  of  surgery,  it  is  certainly  one  of  the  best  with  which  we  are 
acquainted,  though  we  must  add  that  it  belongs  to  a  class  of  books  of  which  we 
do  not  cordially  approve. 

As  to  the  notes  and  comments  of  the  American  editor,  they  are  so  few  and 
brief,  as  scarcely  to  call  for  a  particular  notice;  though  they  contain  one  or  two 
assertions  which  may  excite  surprise.  Thus  Dr.  Flint  states  that  "most  opera- 
tors at  the  present  day,  in  performing  lithotomy,  employ  the  knife  in  some  one 
of  its  modifications  for  the  prostatic  section — indeed  I  know  of  but  a  single  ex- 
ception to  this  practice,  among  distinguished  lithotomists.  My  neighbour  and 
friend  Prof.  Dudley  of  Lexington,  who  has  cut  more  frequently  than  any  living 
surgeon,  and  with  better  success  than  any  man  who  ever  lived,  and  has  furnish- 
ed authentic  reports  of  his  operations,  invariably  uses  the  gorget,  and  all  who 
witnessed  this  gentleman's  operations,  admire  the  dexterity,  precision,  and  de- 
spatch with  which  he  opens  the  bladder  with  this  instrument,  which,  in  most 
other  hands,  seems  clumsy  and  unsafe  beyond  any  that  has  been  invented  for 
the  same  purpose." — P.  460.  As  to  the  use  of  the  gorget,  we  can  only  say  that 
we  have  never  seen  the  prostatic  section  made  in  Philadelphia  with  any  other 
instrument,  and  we  have  witnessed  the  operation  performed  by  Drs.  Gibson, 
Harris,  J.  R.  Barton,  Randolph,  Horner,  Norris,  and  others.  But  perhaps  none 
of  these  are  in  the  estimation  of  Dr.  Flint  distinguished  lithotomists. 


440  Bibliographical  Notices,  [Oct. 

Art.    XXXI. — Medical  Communications  of  the  Massachusetts  Medical  Society, 
Vol.  vii,  pt.  1.     Second  Series,  vol.  iii,  pt.  1.     Boston,  1842:  pp.  76,  8vo. 

The  only  article  in  this  part  of  the  communications  of  the  Massachusetts 
Medical  Society  is  the  annual  address  by  Stephen  W.  Williams,  M.  D.,  &c.  &c. 
In  this  address,  Dr.  W.  gives  a  very  interesting-  medical  history  of  the  county  of 
Franklin,  Mass.,  with  some  brief  notices  of  the  physicians  who  formerly  prac- 
tised in  that  county,  and  have  now  passed  away.  There  is  good  feeling  as  well 
as  good  taste  displayed  in  thus  taking  advantage  of  a  public  occasion  to  do 
homage  to  departed  worth,  and  to  place  upon  record  some  memorials  of  the  early 
practitioners  of  this  country. 

Appended,  are  the  proceedings  of  the  society  for  1842,  and  of  the  councillors 
for  1841-2. 


Art.  XXXII. — A  Series  of  Anatomical  Plates;  with  references  and  physiological 
comments^  illustrating  the  structure  of  the  different  parts  of  the  Human  Body. 
Edited  by  Jones  Quain,  M.  D.,  Prof,  of  Anat.  and  Phys.  in  the  University  of 
London,  and  W.  J.  Erasmus  Wilson,  Lecturer  on  Practical  and  Surgical 
Anatomy  and  Physiology.  By  Joseph  Pancoast,  M.  D.,  Professor  of  Gene- 
ral, Descriptive,  and  Surgical  Anatomy  in  the  Jefferson  Medical  College  of 
Philadelphia,  Lecturer  on  Clinical  Surgery  to  the  Philadelphia  Hospital,  &c. 
&c.  American  edition  revised,  with  additional  notes.  Philadelphia:  Carey  & 
Hart,  for  G.  N.  Loomis,  1842:  4to.  pp.  445,  and  200  plates. 

A  SERIES  of  anatomical  plates  for  the  aid  of  the  student  in  acquiring  a  know- 
ledge of  the  human  structure  has  been  much  wanted,  and  the  present  will  very 
well  supply  the  desideratum. 

The  work  is  arranged  in  five  divisions,  viz:  1.  The  bones  and  ligaments,  illus- 
trated by  thirty  plates;  2d.  The  muscles,  fifty  plates;  3d.  The  heart,  blood-ves- 
sels, lacteals  and  lymphatics,  fifty  plates;  4th.  The  brain,  spinal  marrow,  organs 
of  sense,  and  nerves,  thirty-eight  plates;  5th.  Organs  of  digestion,  respiration  and 
secretion,  thirty-two  plates.  The  plates  are,  for  the  most  part,  exceedingly  well 
executed,  and  are  accompanied  by  letter  press,  containing  detailed  references  to 
the  various  objects  delineated.  When  we  state  that  the  price  of  the  whole  work 
bound,  comprising  445  pages  of  letter  press  and  200  plates,  is  but  fifteen  dol- 
lars, it  is  unnecessary  to  state  that  it  is  the  cheapest  work  of  the  kind  ever  pub- 
lished in  this  country.  The  enterprising  publishers  can  only  be  repaid  by  a  very 
extensive  sale,  and  this  the  work  deserves,  and  will  doubtless  have. 


Art.  XXXIIT. — A  Treatise  on  Amaurosis  and  Amaurotic  Affections.  By  Edward 
OcTAVius  HocKEN.     Philadelphia:  Haswell  &  Johnson,  1842:  pp.  201,  8vo. 

Alt  exposition  of  the  Pathology  of  Hysteria;  elucidated  hy  a  reference  to  the  origin, 
diagnosis,  symptomatology,  pathology  and  treatment  of  Hysterical  Amaurosis, 
By  Edward  Octavius  Hocken,  M.  D.,  M.  R.  C.  S.  L.,  &c.  London:  Samuel 
Highley,  1842:  pp.  32,  12mo. 

We  are  furnished,  in  the  first  of  these  works,  with  a  very  excellent  mono- 
graph of  those  forms  of  imperfection  and  loss  of  vision  classed  under  the  head 
of  amaurosis;  and  in  the  second  with  an  interesting  account  of  the  same  affec- 
tions occurring  in  hysterical  persons,  and  dependent  upon  the  existence  of  what 
has  been  termed  the  hysterical  diathesis. 


1842.]  Lawrence  on  Diseases  of  the  Eye.  441 


Art.  XXXTV. — Elements  of  Surgery.  By  Robert  Liston,  Surgeon  to  the 
North-London  Hospital,  Prof,  of  Clinical  Surgrery,  &e.  &c.  &c.  From  the 
second  London  edition,  with  copious  notes  and  additions.  By  Samuel  D. 
Gross,  M.  D.,  Prof,  of  Surgf.  in  the  Louisville  Medical  Institute,  Surireon  to 
the  Louisville  Marine  Hospital,  &c.  &c.  Illustrated  with  numerous  engrav- 
ings.  Philadelphia:  Edw.  Barrington  &  Geo.  D.  Hasvvell,  1842:  pp.  640,  8vo. 

This  is  a  work  of  established  reputation.  It  has  gone  through  two  editions 
in  Great  Britain,  and  the  same  number  in  this  country.  The  additions  of  the 
American  editor  are  copious,  and  add  materially  to  the  value  of  the  work. 


Art.  XXXV. — j2  Treatise  on  Strabismus,  with  a  description  of  new  instruments 
designed  to  improve  the  operation  for  its  cure  in  simplicity,  ease  and  safety,  illus' 
trated  by  cases.  By  James  Bolton,  M.  D.,  A.  M.,  Member  of  the  Medical 
Society  of  Virginia.     Richmond,  1842:  pp.  36,  12mo.,  plate  1. 

This  little  volume  contains  a  very  brief  account  of  the  muscles  of  the  eyeball, 
of  strabismus,  and  the  operation  for  its  cure,  with  a  description  of  new  instru- 
ments which  the  inventor  conceives  are  calculated  to  improve  the  operation  in 
simplicity,  ease  and  safety — an  opinion  in  wiiich  he  will  not,  probably,  find 
many  who  have  had  any  experience  in  the  operation  to  concur.  Not  the  slight- 
est allusion  is  made  to  the  fascia  of  the  eye,  described  by  Tenon,  a  knowledge 
of  which  is  so  important  for  the  performance  of  the  operation  for  strabismus,  and 
to  which  attention  has  lately  been  called  by  Lucas,  Ferral,  Bonnet,  &c. 

The  volume  is  concluded  with  a  brief  notice  of  eight  cases  in  which  the  author 
has  operated. 


Art.  XXXVI. — A  Treatise  on' the  Diseases  of  the  Eye.  By  W.  Lawrence,  F. 
R.  S.;  Surgeon  Extraordinary  to  the  Queen;  Surgeon  to  St.  Bartholomews, 
and  Lecturer  on  Surgery  at  that  Hospital;  late  Surgeon  to  the  London  Oph- 
thalmic Infirmary,  &c.  &c.  Second  edition  revised,  corrected  and  enlarged. 
London,  1841,  8vo.,  pp.  820. 

Notwithstanding  the  many  and  valuable  works  on  ophthalmic  surgery 
which  have  appeared  within  the  last  three  or  four  years,  the  treatise  of  Mr. 
Lawrence  maintains  its  pre-eminence,  not  only  as  a  work  of  the  highest  autho- 
rity, but  also  for  the  completeness  of  its  plan  and  the  fulness  of  its  details. 

In  an  introductory  chapter,  Mr.  Lawrence  gives  a  very  interesting  account  of 
the  anatomy  and  physiology  of  the  eye  and  its  appendages;  and  then  treats  suc- 
cessively in  separate  chapters  of:— 1st.  The  pathology  of  the  eye— inflammation 
— classification  of  ophthalmic  diseases;  2d.  The  affections  of  the  eyelids;  3d. 
Injuries  of  the  eyeball;  4th.  Causes  of  ophthalmic  inflammation;  5th.  Treat- 
ment of  ophthalmic  inflammation;  6th.  Divisions  and  classification  of  ophthal- 
mic inflammations — simple  and  catarrhal  inflammation  of  the  conjunctiva;  7th. 
Purulent  ophthalmia  of  newly-born  infants;  8th.  Purulent  ophthalmia  in  the 
adult;  9th.  Gonorrhoeal  ophthalmia;  10th.  Erysipelatous  ophthalmia,  pustular 
ophthalmia,  strumous  ophthalmia;  11th.  Variolous,  morbillous,  and  scarlatinous 
ophthalmia;  12th.  Various  affections  of  the  conjunctiva;  13th.  Diseases  of  the 
sclerotica;  14th.  Diseases  of  the  cornea;  15ih.  Diseases  of  the  aqueous  mem- 
brane and  chambers;  16th.  Diseases  of  the  iris;  I7th.  Malformations  and  various 
affections  of  the  iris;  18ih.  Formation  of  an  artificial  pupil;  19th.  AtFections  of 
the  cfioroid  coat,  retina,  vitreous  humour,  lens  and  capsule;  20th.  Amaurosis 
and  other  defects  of  sight;  21st.  Cataract;  22d.  General  affections  of  the  globe; 
23d.  Malignant  diseases  of  the  eye;  24th.  Ossification,  calculous  concretions, 


442  Bibliographical  Notices.  [Oct. 

entozoa  in  the  eye;  25th.  Affections  of  the  orbit;  26th.  Affections  of  the  lachry- 
mal oro^ans. 

Messrs.  Lea  &  Blanchard  will  publish  in  the  course  of  the  present  month,  an 
edition  of  this  work,  illustrated  with  numerous  finely  executed  wood  cuts;  and 
with  considerable  additions. 


Art.  XXX VIT. — T^ree  Memoirs  on  the  Development  and  Structure  of  the  Teeth 
and  Epithelium^  read  at  the  ninth  annual  meeting  of  the  British  Association 
for  the  encourag-eraent  of  Science,  held  at  Birmingham,  in  August  1839;  with 
Diagrams  exhibited  in  illustration.  By  Alexander  Nasmyth,  F.  L.  S.,  F. 
G.  S.,  Member  of  the  Royal  College  of  Surgeons.  London:  John  Churchill, 
1841:  8vo.  pp.  47. 

This  little  volume  presents  a  very  interesting  account  of  the  development  and 
structure  of  the  teeth  and  epithelium;  but  we  must  content  ourselves  with  refer- 
ring those  who  are  interested  in  the  subject  to  the  work  itself,  as  it  would  be 
impossible  to  give  a  satisfactory  description  of  the  views  and  discoveries  of  the 
author  without  the  numerous  diagrams  with  which  it  is  illustrated. 


Art.  XXXVIII. — The  Anatomises  Vade  Mecum;  a  System  of  Human  Anatomy, 
By  Erasmus  Wilson.  Second  edition.  London,  1842:  8vo.,  pp.  595.  With 
1G7  illustrations  by  Bagg. 

This  is  a  perfect  bijou  of  a  book.  The  wood  cuts  are  truly  exquisite,  and  as 
a  mere  work  of  art,  it  is  well  worth  the  price  demanded  for  it.  But  it  has 
higher  claims  on  the  student;  for  the  illustrations  are  not  only  beautiful  but  accu- 
rate; and  the  letter-press  contains  "  in  a  clear,  precise  and  conspicuous  style, 
every  important  detail  of  human  structure,  and  the  most  modern  and  valuable 
discoveries  and  researches  in  the  science  of  anatomy." 

We  are  happy  to  announce  that  an  American  edition  is  in  preparation,  and 
the  portion  of  it  we  have  seen,  is  equal  to  the  original  in  beauty  of  mechan- 
ical execution,  and  it  has,  besides,  some  important  additions,  both  to  the  letter" 
press  and  the  illustrations, 


1842.]  443 


SUMMARY 

OF  THE 

IMPROVEMENTS  AND  DISCOVERIES 

IN  THE 

MEDICAL    SCIENCES. 


ANATOMY  AND  PHYSIOLOGY. 

1 .  Cases  proving  the  Influence  of  the  Cerehro- Spinal  Jlxis  in  the  production  of 
JLnimal  Heat.  By  M.  Brugnoli. — As  pathological  facts  are,  generally  speaking-, 
superior  to  experiments  on  living  animals,  in  so  far  as  the  modifying  powers  of 
the  nervous  system  over  the  various  functions  of  the  body  are  concerned,  the 
following  four  cases  bearing  on  the  influence  of  the  cerebro-spinal  axis  on  the 
production  of  animal  heat,  will  be  read  with  interest. 

1.  A  woman,  45  years  of  age,  after  having  long  suffered  from  severe  pain  in 
the  head  accompanied  with  vertigo,  entered  the  hospital  in  the  following  state. 
Her  look  was  expressive  of  pain,  and  she  supported  the  head  with  both  her 
hands  in  its  every  movement.  She  complained  of  severe  and  fixed  pain  in  the 
occipital  region.  The  respiration  and  circulation  were  natural.  Her  extremi- 
ties were  cold,  the  upper  more  so  than  the  lower,  and  this  coldness  continued  to 
increase  without  being  relieved  by  any  remedy.  Deglutition  became  difficult 
after  a  while,  and  she  died  after  a  period  of  two  months.  A  rounded  cyst,  about 
an  inch  in  diameter,  and  full  of  whitish-green  purulent  matter,  occupied  the  pos- 
terior part  of  the  right  lobe  of  the  cerebellum,  but  made  no  visible  projection  on 
the  surface. 

2.  A  woman  75  years  of  age,  entered  the  hospital  for  a  trifling  afTection  of  the 
digestive  organs,  where  she  was  soon  seized  with  new  symptoms  in  the  form  of 
a  stupor,  difficulty  of  speech,  and  violent  pain  in  the  head.  All  the  limbs  re- 
tained their  mobility,  but  the  upper  extremities  and  the  upper  half  of  the  trunk 
of  the  body  became  as  cold  as  marble.  The  respiration  and  circulation  did  not, 
however,  appear  to  suffer  materially.  Every  remedy  failed  to  restore  the  heat, 
and  she  died  after  five  days  of  suffering.  The  left  hemisphere  of  the  cerebellum 
contained  an  apoplectic  effusion  of  the  size  of  a  large  walnut. 

3.  A  soldier  came  into  the  hospital  on  account  of  a  fixed  severe  pain  in 
the  dorsal  region  accompanied  by  feverish  symptoms.  When  there,  he  had  an 
attack  of  pneumonia,  from  which  he  made  a  slow  and  bad  recovery.  Towards 
the  end  of  winter  a  new  sensation  began  to  be  complained  of;  this  was  a  sensa- 
tion of  coldness,  which  he  could  not  remove  either  by  additional  clothing  or  any 
remedy.  This  sensation  of  coldness  progressively  increased,  but  did  not  seem 
to  affect  the  respiration  or  circulation.  No  symptom  of  paralysis  was  observed, 
and  his  intellectual  faculties  seemed  to  be  perfect  to  the  day  of  his  death,  which 
took  place  eleven  months  after  his  entering  the  hospital.  The  eighth,  ninth, 
and  tenth  dorsal  vertebrae  were  carious,  and  an  abscess  lay  over  their  anterior 
surface.  The  spinal  marrow,  for  an  extent  of  about  two  inches  opposite  these 
vertebrae,  was  in  a  state  atrophy. 

4.  A  vigorous  and  robust  porter,  30  years  of  age,  was  seized,  after  lifting  a 
heavy  burden,  with  general  uneasiness  and  a  sensation  of  intense  cold,  which 
devleoped  itself  over  all  the  surface  of  the  body,  especially  when  the  surface 


444  Progress  of  the  Medical  Sciences,  [Oct. 

was  touohed,  though  the  heat  Avas  actually  greater  than  natural.  The  move- 
ments of  the  body,  and  the  pronunciation  of  words,  were  executed  with  great 
slowness.  The  pulse  was  strong,  severe  pain  was  complained  of  in  the  head, 
and  his  anxiety  was  great.  He  died  on  the  fourth  day.  Coagulated  blood  was 
found  extravasated  beneath  the  theca  of  the  spinal  marrow  from  the  origin  of 
the  first  dorsal  nerves  to  the  extremity  of  the  spinal  marrow.  The  vessels  of 
the  substance  of  the  spinal  marrow  itself  were  also  strongly  injected. 

M.  Brugnoli  thinks  the  above  cases  demonstrative  of  the  influence  of  the 
cerebro-spinal  axis  on  the  development  of  animal  heat.  One  or  two  foreign 
periodicals,  which  also  notice  these  cases,  agree  with  M.  Brugnoli  that  the  cases 
seem  to  lead  to  that  conclusion. — Edln,  Med.  and  Surg,  Jour.  July  1842,  from 
Bulleiino  delle  Sci.  Medicke,  Oct.  1841. 

2.  Irtfiuence  of  the  Nerves  on  Muscular  Irritability. — M.  Longet  found  that  when 
a  nerve  of  voluntary  motion  was  cut  across,  on  the  fourth  day  thereafter,  the 
muscles  to  which  it  was  distributed  could  not  be  excited  to  contract  by  irritating 
the  nerve  by  means  of  a  weak  galvanic  current.  The  muscles,  however,  sup- 
plied by  this  nerve  contract  immediately  on  the  application  of  the  slightest 
stimulus  to  themselves,  even  at  the  end  of  fifteen  days.  Even  after  the  lapse 
of  a  month,  direct  stimulation  causes  them  to  contract  slightly,  and  may  be 
recognized  at  the  end  of  seven  weeks;  no  irritation  of  the  nervous  twigs,  how- 
ever, excites  the  slightest  motion  after  the  fourth  day.  From  the  seventh  week, 
the  muscular  fibre,  already  much  blanched,  seems  to  undergo  a  complete  de- 
generation, and  soon  ceases  to  contract  in  the  slightest,  even  with  the  most  pow- 
erful stimulants.  It  is  only  then  in  consequence  of  a  lesion  of  its  nutrition  that 
muscular  fibre,  in  losing  its  organic  characters,  loses  also  its  essential  charac- 
teristic, irritability,  which,  however,  as  has  been  seen,  remains  a  longtime  after 
all  nervous  influence  has  been  suppressed. — Ibid,  from  Comptes  Hendus,  July, 
1841. 

3.  Influence  of  the  Pneumo gastric  Nerve  on  the  Movements  of  the  Stomach. — M. 
LoNGET  having  opened  many  dogs,  ascertained  that,  in  the  greater  number  of 
them,  irritation  of  the  pneumogastric  nerves  produced  contraction  of  the  stomach. 
Frequently,  during  his  experiments,  he  saw  the  stomach  assume  the  hour-glass 
form.  In  a  few  dogs,  the  movements  of  the  stomach,  on  the  irritation  of  the 
nerve,  were  scarcely  apparent.  After  repealing  his  experiments  on  forty  dogs, 
M.  Longet  recognized  that  the  difference  in  the  results  obtained  depended  on  the 
condition  of  the  stomach  itself.  Thus,  if  the  animal  was  opened  when  the 
stomach  was  full,  irritation  of  the  pneumogastric  nerves  produced  the  most 
marked  movements  of  the  stomach;  but,  when  empty,  scarcely  any  movement 
"was  excited;  in  fact,  the  movements  were  feeble,  just  in  proportion  to  the  time 
which  elapsed  from  the  period  of  chymificalion,  or  filling  of  the  stomach.  He 
thought  these  observations  explained  the  very  different  results  which  expe- 
rimentalists have  arrived  at  regarding  the  influence  of  tliese  nerves  over  the 
movements  of  the  stomach;  as,  if  they  experimented  when  the  stomach  was 
in  different  states,  they  might  logically  arrive  at  opposite  conclusions  from  the 
same  kind  of  experiment.  He  was  never  able  to  excite  any  movement  of  the 
coats  of  the  stomach  by  irritating  or  galvanizing  the  filaments  of  the  great  sym- 
pathetic, or  the  semilunar  ganglia. — Ibid,  from  Ibid.  Feb.  1842. 

4.  On  the  Blood-Globules^  their  Formation  and  their  Use. — M.  Donne  recognizes 
three  kinds  of  particles  in  the  blood, — red  globules,  or  blood-globules,  properly  so 
called,  white  globules,  and  globulines  of  chyle,  as  he  calls  them.  The  red  glo- 
bules are  flat  in  all  kinds  of  blood;  circular  in  the  mammalia;  elliptical  in  fishes, 
reptiles,  and  birds.  The  elliptical  globules  alone  have  a  solid  substance  in  their 
interior;  no  similar  appearance  has  he  been  able  to  delect  in  the  circular  globules. 
Water,  he  says,  renders  the  flat  blood-globules  spherical;  and  acetic  acid  dissolves 
completely  the  round  g-lobules  of  the  mammalia,  but  leaves  an  insoluble  portion 
in  the  elliptical  globules  of  birds,  reptiles,  and  fishes.     This  insoluble  portion,  he 


i 


1842.]  Jlnatomy  and  Physiology.  445 

says,  is  the  central  nucleus.  He  therefore  regards  the  blood-globule  as  com- 
posed of  a  flattened  vesicle  containing  a  solid  nucleus  in  the  elliptical  globules, 
and  a  fluid  only  in  the  circular  ones.  The  elliptical  blood-globule  of  the  camel 
he  found  no  exception  to  the  general  rule  that  those  of  the  mammalia  have  no 
central  nucleus. 

The  white  globules  he  describes  as  colourless,  irregular  in  their  contour, 
and  having  a  granular  aspect,  and  exist  in  the  blood  of  all  animals.  Water 
breaks  them  up,  and  he  imagines  them  to  be  composed  of  a  cyst  containing  three 
or  four  solid  granules. 

-  The  globulines  again  he  describes  as  extremely  small  granules  similar  to 
those  of  the  chyle. 

M.  Donne  gives  the  following  theory  of  the  mode  of  formation  and  uses  of 
these  different  parts.  The  globulines  are  the  product  of  the  chyle,  which  is 
continually  being  added  to  the  blood.  Three  or  four  of  these  unite  together, 
and  whilst  circulating  the  blood,  receive  an  albuminous  envelope.  They  thus 
form  the  white  globules.  The  white  globules  once  formed  change  little  by  little 
their  forms;  become  flattened,  coloured;  the  granular  matter  in  their  interior 
becomes  homogeneous  or  dissolved,  and  they  are  thus  transformed  into  the  red 
or  proper  blood-globules.  The  blood-globules  themselves  have  only  a  passing 
existence;  they  dissolve  after  a  certain  time,  and  constitute  the  so-called  liquor 
sanguinis.  He  says  that  certain  substances,  as  milk,  are  capable  of  being 
immediately  transformed  into  blood-globules  by  being  ejected  into  the  blood- 
vessels; and  he  regards  the  spleen  as  the  organ  more  especially  charged  with 
the  important  function  of  the  manufacture  of  blood-globules.  He  adds,  that  a 
minute  examination  of  the  vascular  tissues  shows,  that  at  no  point  do  the  blood- 
globules  leave  their  vessels  to  assist  in  the  formation  of  the  organs  of  the  body, 
or  to  unite  with  other  organic  elements.  Hence,  he  infers,  it  must  be  the  fluid 
part  of  the  blood  which  transudes  through  the  vascular  walls,  and  that  this  part 
must  be  the  fluid  essentially  concerned  in  the  process  of  organization.— ///zc?. 
from  Ibid.,  7th  March,  1842. 

5.  On  the  Effects  of  an  impermeable  Covering  applied  to  the  Skin. — MM.  Bec- 
QUEREL  and  Breschet  read  a  paper  before  the  Academy  of  Sciences,  on  the 
temperature  of  the  organic  tissues  of  animals,  and  especially  of  rabbits,  the  hair 
of  which  had  been  shaved  off"  and  the  skin  covered  with  an  impermeable  coating 
of  strong  glue,  of  suet,  and  of  resin.  It  was  found  that  the  animals  died  very 
shortly  after  being  covered  with  such  a  coating,  and  these  experimenters  thought 
it  was  by  a  process  of  asphyxia,  in  consequence  of  the  transpiration  from  the  skin 
being  prevented.  It  would  appear  that  they  expected,  from  the  natural  transpi- 
ration being  prevented  by  the  impermeable  coating,  that  the  temperature  of  the 
animal  would  increase,  and  that  a  violent  fever  would  be  produced,  under  which 
the  animal  would  expire.  But  the  very  opposite  happened.  Thus,  the  temper- 
ature of  the  first  rabbit,  before  it  was  shaved  and  covered  with  the  impermeable 
coating,  was  38°  Cent.,  but  immediately  after  the  coating  was  dried  it  was 
found  that  the  muscles  of  the  thigh  and  of  the  breast  had  fallen  in  temperature 
to  32°  Cent.  An  hour  afterwards,  the  temperature  had  fallen  to  24.°5  Cent.  In 
another  rabbit,  the  coating  on  which  was  put  on  with  more  care,  as  soon  as  the 
coating  was  dried,  its  temperature  was  found  to  have  fallen  so  much  as  to  be 
only  3°  above  that  of  the  surrounding  atmosphere,  which  was  on  that  day  17° 
Cent.     One  hour  after  this  the  animal  died. 

These  experimentalists  afterwards  made  some  experiments  in  order  to  ascer- 
tain the  relative  difference  of  heat  between  venous  and  arterial  blood.  They 
introduced  delicate  thermometers  for  this  purpose  into  the  auricles  of  the  heart 
of  dogs,  and  invariably  found  that  the  arterial  blood  was  a  few  fractions  of  a 
degree  higher  than  that  of  the  venous  blood. — Ibid,  from  Ibid.,  Oct.  1841. 

6.  On  the  Coloration  of  the  Bones  by  Madder. — MM.  Serres  and  Doyere  have 
been  engaged  for  upwards  of  two  years  in  a  long  course  of  experiments  on  the 
coloration  of  the  bones  of  living  animals  by  feeding  them  with  madder,  and 

No.  VIII.— October,  1842.  38 


446  Progress  of  the  Medical  Sciences.  ["Oct. 

have  at  length  arrived  at  some  very  curious  and  interesting  results  both  with 
regard  to  that  subject  and  the  mode  in  which  bone  is  formed.  They  found  that 
when  an  animal  was  fed  for  a  long  time  on  madder,  not  only  were  the  bones 
coloured  of  a  rose  hue,  but  all  the  other  solids  and  fluids  of  the  body,  with  the 
exception  of  the  tendons  and  cartilages  and  the  white  substance  of  the  brain.  In 
the  bones  alone  they  found  this  colour  to  be  permanently  fixed,  and  not  remov- 
able by  maceration,  nor  by  certain  chemical  solvents  of  the  colouring  matter  of 
madder.  Maceration,  however,  removed  the  colouring  matter  from  all  the  other 
tissues.  They  ascertained,  from  a  chemical  investigation,  that  it  was  the  phos- 
phate of  lime  which  held  permanent  the  colouring  matter  of  madder  in  the 
bones.  They  found  that  the  colouring  matter  did  not  penetrate  the  bones  to  any 
depth,  but  the  distribution  of  the  colour  was  remarkable  as  throwing  much  light 
on  the  true  structure  of  the  osseous  tissue. 

When  a  long  bone  coloured  with  madder  is  sawed  transversely,  the  coloured 
portion  is  observed  to  penetrate  but  a  little  depth,  forming,  as  it  were,  a  circle 
round  the  bone.  When  this  section' is  examined  by  means  of  a  magnifying 
power  of  twenty  diameters  or  so,  the  colouring  matter  is  seen  to  exist  as  red  points 
scattered  over  a  white  ground.  When  a  power  of  two  or  three  hundred  diameters 
is  used,  each  point  is  seen  to  to  be  in  reality  a  coloured  circle  surrounding  a 
round  aperture  in  the  substance  of  the  bone.  A  longitudinal  section  of  the  same 
bone  exhibits  the  true  structure  of  the  bone  more  particularly:  and  proves  that 
this  rounded  aperture  seen  surrounded  by  a  coloured  ring  in  the  transverse  sec- 
tion, was  the  section  of  a  minute  canal,  or  capillary  vessel,  which  is  more  deli- 
cate as  the  animal  is  older.  The  coloured  ring  surrounding  it  was  seen  to  be  the 
walls  of  this  canal,  or  that  part  of  the  bony  structure  which  constituted  its 
walls,  and  which  differed  in  no  respect  from  the  uncoloured  portion  of  the  bony 
tissue  which  surrounded  it. 

The  most  exterior  layer  of  colouring  matter  seen  on  the  outer  surface  of 
the  bone  was  found  to  consist  of  a  coloured  layer,  as  thin  as  that  which  was 
seen  surrounding  each  bony  capillary  vessel  in  the  interior  of  the  bone.  The 
bone  then  was  seen  only  to  be  coloured  at  those  portions  which  were  in  imme- 
diate contact  with  the  capillary  vessels  of  its  tissues  or  of  the  periosteum,  and 
at  no  other  part. 

MM.  Serres  and  Doyere  next  pass  to  the  examination  of  what  it  has  been  the 
custom  of  late  to  describe  as  the  osseous  corpuscles,  and  they  show,  by  the  sim- 
plest of  all  experiments,  viz.  by  allowing  a  drop  of  oil  to  come  in  contact  with 
a  slice  of  bone  under  the  microscope,  that  these  so-called  osseous  corpuscles, 
on  which  so  much  stress  has  been  laid,  are  neither  more  nor  less  than  micro- 
scopic deceptions, — are,  in  fact,  cavities  or  empty  cells,  which  they  think  are 
possibly  filled  with  a  fluid  during  life,  but  not  with  the  circulating  fluid,  as  they 
are  never  coloured  with  madder. 

These  experimentalists  ascertained  another  important  fact.  They  fed  a  young 
pigeon  with  madder  from  the  10th  March  to  the  15th  of  April  1840,  when  they 
amputated  the  wing,  and  found  the  bones  deeply  stained  with  the  colouring  mat- 
ter. The  madder  was  then  stopped;  it  was  nourished  on  the  ordinary  food  of 
these  animals;  and  on  the  30th  of  January  1841,  the  other  wing  was  cat  off, 
from  the  effects  of  which  operation  it  died.  Though  this  was  a  young  animal, 
only  four  months  old  when  it  lost  its  first  wing,  and  though  the  bones  had  been 
exposed  to  the  incessant  vital  actions  for  so  many  months  after  the  madder  was 
stopped,  its  bones,  when  it  died,  presented  the  very  same  depth  of  colour  as  the 
wing  which  had  been  amputated  so  many  months  before.  MM.  Serres  and 
Doyere,  therefore,  justly  infer,  that  the  asserted  incessant  change  or  renewal  of 
the  molecules  is  not  an  essential  condition  of  the  living  tissues,  unless  bones  are 
henceforth  to  be  ranged  amongst  the  dead  ones. 

From  these  investigations,  then,  it  appears  that  the  staining  in  the  bones  by 
madder  is  purely  a  chemical  process, — a  species  of  dyeing.  That  in  the  coloured 
ring  which  the  naked  eye  discovers  on  the  long  bones,  the  colouring  matter  is 
confined  to  that  portion  of  the  osseous  tissue  in  contact  with  the  periosteum, 
and  that  forming  the  immediate  walls  of  the  capillary  vessels  of  the  bone. 


1842.]  Materia  JMedica  and  Pharmacy,  447 

That,  as  the  distance  of  each  capillary  vessel  from  each  other  is  more  than 
double  the  breadth  of  the  coloured  layer  surrounding  each,  even  in  the  coloured 
ring-  the  greater  portion  of  the  bone  is  really  uncoloured,  really  white.  And, 
lastly,  that  the  dyeing  of  the  bone  is  influenced  by  the  mode  in  which  the  blood 
is  distributed  through  it;  some  bones,  from  the  peculiarities  of  their  circulation, 
being  coloured  from  within  outwards,  otherwise  from  without  inwards. — Ibid, 
from  Ibid.,  Feb.  1842. 

7.  Physiological  Observations  on  Double  Uterus. — M.  Dumas  relates  in  the  Jour- 
nal de  la  Soc.  de  Med.  Pratique  de  Montpelier,  a  case  of  double  uterus  observed  by 
himself,  and  refers  to  a  number  of  similar  cases,  from  a  comparison  of  which  he 
draws  the  following  conclusions. 

1st.  The  menstrual  discharge  may  continue  from  the  empty  uterus,  whilst  the 
other  contains  an  embryo. 

2.  The  two  uteri  do  not  influence  each  other  to  such  a  degree,  as  that  the 
empty  one  should  be  always  under  the  immediate  influence  of  the  other  which 
is  fecundated. 

3.  The  woman  may  be  a  virgin  as  regards  the  left  one,  and  with  child  in  the 
right,  and  vice  versa,.  She  may  be  at  the  full  time  with  the  one,  and  in  labour, 
while  with  the  other  she  is  not  near  her  period. 

4.  Superfetation  may  take  place  in  cases  of  double  uterus  with  double  neck 
and  OS  uteri,  and  also  in  cases  of  double  uterus  with  single  neck  and  os  uteri. 

5th.  Notwithstanding  the  absence  of  anatomical  proof  of  the  existence  of  super- 
fetation  in  cases  of  double  uterus,  its  possibility  ought  to  be  admitted  in  legal 
medicine. 

6th.  In  well  marked  cases  of  double  uterus,  there  will  be  an  inclination  to  the 
same  side  that  the  fertile  womb  is  on;  and  all  the  symptoms  will  be  slightly 
different  from  those  observed  in  a  case  of  single  uterus. 

7th.  Although  it  cannot  be  laid  down  as  a  principle,  that  each  cavity  of  the 
double  uterus  can  become  so  developed,  as  to  be  able  to  contain  a  foetus  at  the 
full  period,  yet  we  can  believe  in  frequent  abortions, 

8th.  The  double  uterus,  when  enlarged,  renders  labour  and  the  expulsion  of 
the  after-birth  difficult,  and  facilitates  the  laceration  of  the  soft  parts. 

9th.  Thanks  to  the  form  observed  by  M.  Martin  St.  Ange,  (in  which  the 
cavity  of  the  neck  of  the  uterus  communicated  with  that  of  the  body,  by  a  nar- 
row canal  thirteen  millimetres  in  length,)  we  can  explain  the  retention  of  the 
secundines,  and  the  difficulty  experienced  in  their  extraction,  when  the  canal 
which  retains  them  has  not  previously  been  sufficiently  dilated. — Gazette  Med. 
de  Paris,  4  Feb.  1842. 

8.  Transposition  of  the  Viscera. — M.  Gerdy  communicated  to  the  French  Aca- 
demy of  Medicine  22d  Feb.,  a  case  of  transposition  of  all  the  organs;  even  the 
cavities  of  the  heart  were  transposed. 


MATERIA  MEDICA  AND  PHARMACY. 

9.  Emmenagogue  Solution. — M.  Bouchardat  recommends  the  following  as 
an  emmenagogue: — Chloro-aurati  ammonise,  ten  grains;  distilled  water,  300 
scruples;  alcohol,  36°,  300  scruples.  Make  a  solution,  and  preserve  in  a  well- 
stoppered  vessel.  This  preparation  is  used  with  much  advantage  in  cases  of 
amenorrhoea  and  dysmenorrhcea,  arising  from  debility,  and  is  far  superior  to  other 
preparations  of  gold,  such  as,  for  instance,  the  eyanuret  of  that  metal.  It  is 
given  morning  and  evening  in  the  dose  of  a  coffee-spoonful  in  a  cupful  of  pure 
water,  duly  sweetened.  The  chloro-aurate  of  ammonia  is  obtained  by  dissolv- 
ing one  part  by  weight  of  the  perchloruret  of  gold  with  two  parts  by  weight  of 
the  hydro-chlorate  of  ammonia,  in  a  sufficient  quantity  of  distilled  water,  aiding 
the  solution  by  the  addition  of  a  few  drops  of  weak  nitro-muriatic  acid  (aqua 


448  Progress  of  the  Medical  Sciences.  [Oct. 

regia).     The  compound  salt  must  be  afterwards  dried  by  a  gentle  heat. — Prov, 
Med.  Journ.  July  2,  1842,  from  Annuaire  de  Therapeutique. 

10.  Chalybeate  Preparations. — Mr.  VVm.  Tyson  gives  the  following  formulae 
for  some  chalybeate  preparations  which  he  extols  as  highly  useful. 

"The  most  valuable  preparations  of  iron,  are,"  he  observes,  "those  which 
have  the  deutoxide  for  their  base,  as  in  the  mineral  waters,  and  in  the  formula  I 
am  about  to  give  you. 

Liquor  Oxysulphatis  Ferri. — R.  Ferri  sulphat.  ^ij  (or  3iij);  acidi  nitrici,  ^iij; 
aqiioe  dist.,  giss. 

Tere  diligenter  per  horse  quadrantem  acidum  nitricum  ferro  vitriolato,  dein 
sensim  addendo  aquam,  per  chartam  cola,  et  fiant  guttse,  e  quibus  capiat  seger 
gtt.  V — xij  bis  in  dies  ex  infuso  quassise  vel  aqua. 

This  form,  I  believe,  was  invented  by  Sylvester,  about  fortyy  ears  ago,  and  has 
ever  since  that  time  been  in  constant  use  among  the  practitioners  of  Derbyshire. 
I  wonder  it  has  not  been  inserted  into  the  Pharmacopoeia,  as  it  is  by  far  the  best 
and  most  powerful  of  all  the  preparations  of  iron.  The  oxygen  of  the  nitric 
acid  uniting  with  the  sulphate  of  iron,  forms  a  persulphate;  at  the  same  time  the 
iron  is  converted  into  red  oxide.  As  a  medicine  it  far  surpasses  the  tine,  ferri 
mur.,  and  it  never  precipitates  the  oxide  of  iron.  It  is  one  of  the  most  valuable 
restoratives  in  the  debility  and  torpor  of  the  liver,  which  remains  after  the  suc- 
cessful treatment  of  hepatitis.  Patients  do  not  well  bear  above  ten  or  twelve 
drops  to  a  dose;  and  when  given  with  small  doses  of  sulphas  magnesias,  &c.,  it 
equals  the  purgative  mineral  waters.  I  think  it  will  be  found  to  be  an  antidote 
to  prussic  acid,  as  it  instantly  combines  with  it. 

This  form  having  the  red  oxide  for  its  base,  enables  me  to  obtain  some  of  the 
mildest,  most  efficacious,  and  beautiful  of  the  preparations  of  iron. 

Ferri  hitartras.  R. — Ferri  sulphatis,  ,^iij;  acidi  nitrici,  ^iss.  Tere  simul 
guttatim: — cessata  effervescentia,  adde,  aquse  font.,  ^vj;  potassas  supertart.  gv], 
Coque  et  liquorum  tepidum  per  chartam  cola;  fiat  sal  siccum,  s.  a.     Dose,  gr, 

V XX. 

The  sulphate  of  potass  here  produced,  adds  greatly  to  the  efficacy  of  the 
medicine,  rendering  it  gently  aperient. 

Potassio-tartras  ferri.  R. — Ferri  sulphatis,  ^vj;  acidi  nitrici,  ^iij.  Tere 
simul  guttatim  per  horae  quadrantem,  et  adde,  aquae  font.,  ^vj.  Misce  et  per 
chartam  cola,  cui  adde  potassae  carbonat.,  gvj — et  sepone  per  aliquot  horas; 
liquorem  supernatantem  effunde,  ex  oxido  precipitato  adde,  bitartratis  potassae, 
5iss;  aquae  font.,  ^viij.  vel,  q.  s. 

Decoque  et  per  chartam  cola; — leni  calore  consumatur  liquor  ad  pulverem 
siccum.     Dose,  the  same. 

These  two  preparations  dissolved  in  boiling  water,  continue  in  solution  when 
cold. 

Ammonio-tartras  ferri. — R.  acidi  tartarici,  ^ij;  ammoniae  carb.,  5j;  aquae 
font.,  ^vj,  vel,  q.  s.  Misce  fiat  solutio. — R  liq.  ferri  oxysulph.,  ^j;  liq.  potas- 
sae, q.  s.     M. 

Wash  the  precipitate  with  distilled  water  upon  a  filter;  add  the  oxide,  while 
in  the  state  of  hydrate,  to  the  above  solution,  and  with  a  gentle  heat  dissolve 
the  iron,  and  evaporate  to  dryness.  Vel,  R  liq.  oxysulphat.  ferri,  5j;  potassae 
subcarb.,  ^iij;  aquas  font.,  gvj.     M, 

The  precipitated  oxide  to  be  treated  as  above.     Dose,  gr.  v— x. 

Perfectly  soluble  in  water.  Contains  about  one  grain  in  four  of  deutoxide  of 
iron. 

Here  we  have  three  preparations  of  tartrate  of  iron,  which,  when  mixed  with 
a  due  proportion  of  water,  are  remarkable  for  their  solubility,  and  the  beautiful 
golden  colour  of  the  solution;  hence  they  form  elegant  mixtures  for  medicinal 
purposes. 

Liquor  ferri  biniodidi. — R  potassae  hydriodat.,  gss;  aquae  purae,  ^x.  Misce, 
et  adde  liq.  ferri  oxysulph.,  ^ij.     M.     Dose,  gr.  xx— xxx,  bis  die. 

This  solution  is  of  a  beautifully  deep  red  colour,  and  transparent.  It  contains, 


1842.]  Materia  Medica  and  Pharmacy.  449 

like  most  other  iodides,  a  little  free  iodine;  but  retains  its  colour,  and  does  not 
part  with  its  iron;  for  I  have  some  now  by  me  which  was  made  six  years 
ago,  and  the  only  deposit  is  a  little  sulphate  of  potass.  The  liquor  oxysulphatis 
ferri  is  also  a  test  for  the  purity  of  hydriodate  of  potash,  producing  in  the  above 
proportions  a  deep  transparent  solution. 

In  medicine,  as  well  as  in  the  arts,  much  disappointment  would  be  avoided, 
and  much  advantage  gained,  in  attending  to  the  base,  that  is  to  say,  to  the  state 
of  oxidation  of  the  mineral  made  use  of;  each  oxide  possessing  essential  pro- 
perties, differing  materially  from  each  other.  This  we  have  already  seen  in  the 
observations  upon  antimony  and  mercury;  but  it  is  more  particularly  evinced  in 
the  use  of  copper.  In  copper  we  have  a  valuable  tonic  and  astringent  in  some 
cases  of  epilepsy,  chorea,  and  uterine  hemorrhage;  but  nearly  all  the  prepara- 
tions now  in  use  are  unmanageable,  as  they  contain  peroxide,  which  is  poison- 
ous; while  the  protoxide  is  nearly  inert.  Even  the  ammoniaret,  which  is  the 
mildest  of  them  all,  still  requires  the  greatest  care,  as  it  also  contains  peroxide. 
— Lancet,  June  25,  1842. 

11.  Mode  of  preserving  Nitrate  of  Silver. — M.  Dumeril  has  for  a  long  while 
employed  a  very  simple  process  for  preserving  the  nitrate  of  silver  from  the  in- 
jurious effects  of  exposure  to  the  air,  when  run  into  sticks.  It  consists  in  merely 
coating  the  caustic  with  engraver's  sealing-wax,  which  contains  a  large  quantity 
of  shellac.  This  wax  adheres  very  well,  and  forms  a  strong  and  smooth  var- 
nish, as  it  were,  which  remains  unaffected  by  the  atmosphere.  Thus  protected 
the  nitrate  no  longer  stains  the  fingers,  injures  the  caustic-case,  nor  is  in  any 
way  changed  by  the  moisture  in  the  air,  possesses  a  greater  degree  of  solidity, 
and,  at  the  same  time,  the  process  is  of  exceeding  service  in  practice,  inasmuch 
as  when  wanted  for  use,  a  small  part  only  of  the  caustic  need  be  uncovered  by 
means  of  a  penknife,  so  that  its  application  can  be  restricted  to  the  part  where 
it  is  required.  This  is  of  peculiar  utility  in  ulceration  of  the  throat,  aphthae, 
fissures,  &c. — Prov,  Med.  Journ.  July  2,  from  Bull,  de  Therap. 

12.  External  application  of  Croton  oil — Whenever  it  is  required  to  use  this 
method  of  counter-irritation,  M.  Bouchardat  strongly  recommends  a  plaster  which 
has  been  much  used  by  M.  Chomel  at  the  Hotel  Dieu,  and  which  is  thus  pre- 
pared: Four  parts  of  diachylon-plaster  are  melted  at  a  very  gentle  heat,  and 
while  it  is  half  liquid  one  part  of  croton  oil  is  mixed  with  it,  and  the  mixture  is 
then  spread  in  a  thick  layer  on  calico.  Pieces  cut  from  this  may  be  applied  to 
the  skin,  like  ordinary  sticking-plaster,  and  quickly  produce  an  active  irritation. 
—B.  ^  F.  Med.  Rev.  July  1842,  from  Bull.  Gen.  de  Therapeutique,  March,  1842. 

13.  On  the  use  of  the  Ergot  of  Rye. — Dr.  Geo.  Fife  states  that  the  ergot  of 
rye  is  a  useful  medicine  in  polypus  uteri,  attended  with  profuse  hemorrhage, — 
menorrhagia,  where  there  is  no  inordinate  action  of  the  heart  or  arteries,  or  mor- 
bid sensibility  of  the  uterine  system, — in  leucorrhoea,  when  independent  of 
inflammatory  action, — in  chlorosis  with  amenorrhcea, — and  in  dysmenorrhoea. 
The  first  time  Dr.  Fife  saw  the  ergot  exhibited,  was  by  the  late  Dr.  Parr,  of 
Newcastle-upon-Tyne,  in  1828.  "It  was  in  a  case  oi  polypus  of  the  uterus,^ 
accompanied  with  frequent  and  frightful  attacks  of  hemorrhage.  He  gave  the 
ergot  after  all  ordinary  means  had  proved  unavailing.  The  effect  produced  was 
not  only  the  moderation  of  the  hemorrhage,  but  also  the  expulsion  of  large  and 
numerous  masses  of  the  tumour,  in  many  of  which  a  distinct  fibrous  structure 
was  perceptible.  After  its  continued  employment,  the  woman,  who  had  arrived 
at  the  climacteric  period,  enjoyed  comparative  health  and  comfort,  being  freed 
from  the  repeated  and  alarming  hemorrhages,  and  experiencing  no  inconvenience 
from  the  small  portion  of  the  tumour  which,  when  last  examined,  still  remained. 
In  certain  cases  of  menorrhagia,  Dr.  F.  has  found  this  medicine  of  the  greatest 

*  Vide  Monthly  Journal,  p.  416, 1841,  (Mr.  Moyle's  paper,)  and  p.  570  (Dr.  Sommer- 
ville's  paper.) 

38* 


450  Progress  of  the  Medital  Sciences.  [Oct. 

value.  "In  this  disease,"  he  remarks,  "it  is  necessary  to  ponder  well  on  the 
individual  circumstances  of  each  case,  and  to  use  the  utmost  caution  in  ascer- 
taining the  cause  on  which  the  disease  depends;  as  where  such  precaution  has 
been  neglected,  it  has  been  my  lot  to  see  both  the  sufferings  and  danger  aggra- 
vated by  the  ergot.  In  this  respect  it  does  not  differ  from  other  active  medi- 
cines. The  slightest  reflection  will  suffice  to  call  to  mind  the  very  different 
states  of  the  system  in  which  this  disease  occurs.  It  may,  for  example,  hap- 
pen in  the  most  phlogistic  and  plethoric,  or  it  may  arise  in  a  person  of  a  diame| 
trically  opposite  constitution.  If  given  in  the  first  state,  it  is  decidedly  preju- 
dicial, unless  preceded  by  such  means  as  are  calculated  to  remove  alike  the 
plethora  and  morbid  sensibility;  and  even  when  this  has  been  done,  its  operation 
requires  to  be  carefully  observed.  In  the  last,  it  acts  most  beneficially,  as  it 
at  once  raises  the  nervous  energy  of  the  uterus,  and,  through  this  medium,  pro- 
bably imparts  increased  tone  to  the  relaxed  and  debilitated  vessels  from  which 
the  exhalation  takes  place."  "  In  several  distressing  cases  of  leucorrhoea,  where 
the  strongest  astringent  injections  had  been  employed  without  any  effect,  except 
exciting  inflammatory  action  which  did  not  previously  exist,  I  have  found  the 
ergot,  aided  by  injections  of  simple  warm  water,  or  the  decoction  of  poppy  cap- 
sules, perfectly  successful."  In  this  disease,  it  is  particularly  necessary  to 
attend  to  the  state  of  the  system  and  the  nature  of  the  uterine  disorder,  before 
deciding  upon  exhibiting  the  ergot.  "  In  chlorosis  and  amenorrhoea^  I  have,"  says 
Dr.  F.,  "  frequently  experienced  the  good  effects  of  the  ergot  after  aloes,  iron, 
valerian,  cantharides,  &c.,  had  all  been  employed  without  the  slightest  advan- 
tage. In  those  cases  where  extreme  nervous  sensibility  exists,  it  may  be  most 
advantageously  combined  with  the  valerian,  and  where  the  alvine  system  is  tor- 
pid, with  aloes."*  In  dysmenorrhoea.  Dr.  Fife  found  it  very  useful;  and  in  one 
very  severe  case,  wherein  he  combined  it  with  valerian,  "  it  appeared  almost 
magical  in  its  operation."  The  doses  recommended  are  gr.  x  to  ^i  of  the  pow- 
der, and  5SS  to  ^i  of  the  concentrated  tincture;  but  how  frequently  administered 
is  not  stated.  In  one  case  of  menorrhagia,  ^ss  was  ordered  to  be  taken  in  ^1 
doses,  every  three  or  four  hours.  As  to  the  modus  operandi,  practical  men  will 
care  little  if  the  facts  are  found  to  be  as  Dr.  F.  and  others  report  them  to  be. 
However,  it  is  not  difficult  to  see  how  "a  congested  state  of  the  uterine  vessels 
will  in  one  person  lead  to  menorrhagia — the  same  cause  operating  on  a  different 
constitution  will  be  attended  with  leucorrhoea."  Again,  when  the  nervous  sys- 
tem of  the  uterus  is  at  fault,  we  in  one  person  have  chorea,  in  another  simple 
hysteria,  in  others  cardiac  and  pulmonary  symptoms. — Lond.  and  Edin,  Month, 
Journ.,  Feb.  1842,  from  London  Med.  Gaz.,  June  18th,  1841. 

14.  Ergot  of  Rye. — Dr.  Wm.  Catlett,  in  a  paper  in  the  Edinburgh  Med.  and 
Surg.  Journ.  for  .January  last,  endeavours  to  illustrate  certain  pathological  effects 
of  this  drug  when  administered  to  the  parturient  female,  which  do  not  appear  to 
have  especially  attracted  the  attention  of  the  profession.  These  are,  1st,  The 
supervention  of  puerperal  convulsions.  This  complication  he  holds  to  be  clearly 
traceable  to  the  ergot  in  three  cases  which  he  reports,  and  the  circumstances  of 
which  differed  considerably  from  each  other.  His  experience  is  decidedly  op- 
posed to  the  practice  recommended  by  Dr.  Stearns,  of  employing  ergot  in  cases 
where  convulsions  have  occurred,  and  as  a  preventative  in  protracted  labours 
when  they  appear  imminent.  2d,  The  production  of  true  hour-glass  contraction 
of  the  uterus.  The  circumstances  under  which  this  effect  is  likely  to  follow  the 
use  of  the  ergot,  are  some  such  concatenation  of  circumstances  as  the  follow- 
ing:— a  lymphatic  state  of  the  maternal  constitution — a  nervous  temperament-w 
lingering  labour  from  defective,  natural  contractions  of  the  womb,  which  the 
administration  of  ergot  has  not  succeeded  in  improving — and  this  state  connect- 
ed with  the  previous  death  of  the  child  in  utero.  3d,  Its  tendency  to  produce 
hydrocephalus  in  the  early  stage  of  infantile  life.  To  substantiate  this,  the 
author  reports  five  cases  where  the  ergot  was  administered  under  various  cir- 

*  As  an  emmenogoguc,  Dr.  F.  prefers  the  Barbadoes  to  the  Socotrine  aloes. 


1842.]  Materia  Medica  and  Pharmacy.  451 

cumstances  of  labour,  and  in  all  of  which  the  child  died  with  symptoms  of 
hydrocephalus  at  various  periods,  from  the  8th  day  to  the  end  of  the  second 
month  after  birth.  "It  will  be  seen,"  he  observes,  "that  of  these  cases,  there 
are  none  connected  with  a  first  delivery,  or  any  in  which  the  child  was  sub' 
jected  to  very  lengthened  or  forcible  impaction.  Is  there  any  warrant  from  this 
fact,  to  infer  that  the  ergot  had  here  exerted  any  specific  influence  upon  the  fce- 
tal  constitution,  as  alluded  to  by  Dr.  F.  H.  Ramsbotham,  independent  of  the 
extra-mechanical  pressure  induced  by  its  action]  It  becomes,  indeed,  a  very 
interesting-  question,  if  it  be  admitted  that  ergot  has  an  agency  in  the  cerebral 
disturbance  thus  set  up  in  the  infant  economy,  to  determine  in  what  manner  it 
is  effected,  whether,  as  above  hinted,  it  be  a  purely  mechanical  effect,  or  occur- 
ring through  the  medium  of  direct  absorption  into  the  fcBtal  system.  The  short 
period  which  was  allowed  for  its  operation  in  the  cases  adduced,  militates 
against  this  conclusion,  but  by  no  means  renders  it  impossible.  The  effects 
that  ergot  is  admitted  to  exert  on  the  cerebro-spinal  axis,  are  generally  stated  to 
be  those  constituting  the  leading  symptoms  of  narcotism,  viz.,  dilatation  of 
pupil,  giddiness,  delirium,  and  stupor,  and  this  might,  with  no  great  latitude  of 
argument,  be  insisted  upon  as  probably  opening  up  a  sufficiently  morbid  action 
to  constitute  predisposition."  Dr.  Catlett's  estimate,  in  the  conclusion  of  his 
paper,  of  the  true  value  of  the  ergot,  as  applicable  to  obstetric  practice  is,  that  it 
is  a  substance  of  energetic  power,  the  employment  of  which  in  the  stages  of 
labour  antecedent  to  the  birth  of  the  child,  is  generally  contra-indicated,  and  only 
admissible  where  there  is  serious  hemorrhage  from  partial  detachment  of  the 
placenta,  accompanied  by  deficient  uterine  tone.  But  in  the  last  stage  of  partu- 
rition, it  may  be  of  essential  service  in  checking  hemorrhage  from  whatever 
cause. — Ibid. 

15.  Ergot. — M.  BoNJEAN,  of  Chambery,  has  determined  by  numerous  experi- 
ments— 1st,  That  the  ergot,  gathered  the  first  day  of  its  formation,  has  not  the 
poisonous  properties  which  it  possesses  when  taken  on  the  sixth  day.  2d,  That 
a  heat  of  100°  C.  (212°  Fr.)  produces  the  same  effect  as  gathering  it  too  early. 
3d,  That  fermentation  also  deprives  it  of  its  properties.  4th,  That  old  and  da- 
maged ergot  loses  nothing  in  this  respect;  which  circumstances  are  important,  as 
they  serve  to  explain  the  want  of  success  which  sometimes  attends  its  adminis- 
tration. 

M.  Bonjean  has  discovered  two  different  active  principles: 

1st,  One  which  acts  as  a  poison,  is  the  oil  of  ergot,  of  a  uniform  consistence, 
an  acrid  flavour,  a  yellowish  colour,  soluble  in  cold  ether  and  in  boiling  alcohol, 
possesses  poisonous  properties  in  a  high  degree.  The  author  considers  that 
twelve  grammes  of  this  oil  are  equivalent  to  thirty-two  grammes  of  the  ergot  of 
rye;  but  he  has  observed,  that  at  a  temperature  of  80°  or  100°  (C.)  it  loses  these 
violent  properties,  and  becomes  converted  into  a  resin.  It  is,  therefore,  better  to 
prepare  it  with  cold  ether. 

2d,  The  aqueous  extract  is  obtained  by  treating  with  water  the  powder,  either 
deprived  of  its  oil  or  not;  it  is  brown,  of  a  thick  consistence  and  musty  smell. 
It  is  soluble  in  water,  and  can  be  formed  into  mixtures,  syrups,  pills,  &c.  It  is  not 
at  all  poisonous,  but  possesses  very  decided  anti-hernorrhagic  properties,  which 
induced  the  author  to  call  it  anti-hemorrhagic  extract;  but  it  appears,  that  to 
name  a  product,  which  has  been  but  little  examined,  according  to  one  of  its 
effects,  is  objectionable.  M.  Blanc,  of  Aix-les-Bains,  has  obtained  excellent 
effects  from  the  use  of  this  extract;  in  a  case  of  abundant  and  obstinate  hemor- 
rhage, giving  from  fifty  centigrammes  to  one  gramme  in  the  course  of  the  day. 
M.  Bonjean  thinks  it  applicable  to  hemorrhages,  whether  simple  or  puerperal. 

He  insists  on  the  real  advantage  of  separating  the  two  active  principles  by 
analysis,  the  styptic  extract  and  the  poisonous  oil. — Pharmaceutical  Journal, 
Jan.  1842,  from  Journal  de  Chimie  Med. 


452  Progress  of  the  Medical  Sciences,  [Oct. 

MEDICAL  PATHOLOGY  AND  THERAPEUTICS  AND  PRACTICAL 

MEDICINE. 

16.  Observations  on  the  Prevention  and  Treatment  of  Apoplexy  and  Hemiplegia, 
— Dr.  Marshall  Hall  read  to  the  Medical  Society  of  London  in  April  last  an 
interesting  paper  on  this  subject. 

'*The  question,"  he  remarked,  "of  the  causes,  nature,  prevention,  and  treat- 
ment of  apoplexy  and  hemiplegia  was  a  very  complicated  one.  He  thought 
the  attention  of  physicians,  in  reference  to  the  prevention  and  treatment  of  apo- 
plectic and  hemiplegic  attacks,  had  been  far  too  much  confined  to  the  question 
of  plethora  as  the  disease,  and  of  depletion  as  the  remedy.  It  was  to  him  certain 
that  such  attacks  might  and  did  occur  quite  irrespective  of  general  plethora; 
nay,  that  they  occurred  in  connection  with  the  opposite  condition  of  the  system, 
that  of  inanition  and  anaemia.  Nor  was  a  state  of  anaemia  the  only  other  condi- 
tion besides  plethora  which  led  to  the  apoplectic  or  hemiplegic  attack.  Mor- 
bid conditions  of  the  stomach  and  morbid  conditions  of  the  intestines  were  other 
sources  of  these  seizures.  But  he  had  also  observed  the  occurrence  of  apoplec- 
tic affections  under  other  circumstances;  other  indubitably  predisposing  causes 
of  the  apoplectic  seizure  were  dyspepsia,  cachexia,  and  gout.  Nor  was  even 
this  view  of  the  subject  sufficiently  extended;  the  liver  and  the  kidney  must  do 
their  office.  These  sources  of  the  apoplectic  or  hemiplegic  seizure  consisted  in 
conditions  of  the  general  circulatory  system,  and  of  the  blood  itself.  There  were 
still  others  of  a  different  kind. 

"The  first  of  these  was  disease  of  the  heart;  and  this  consisted,  first,  in  hy- 
pertrophy, with  augmented  impulse  given  to  the  arterial  blood;  or,  second,  in 
dilatation  of  the  heart  and  disease  of  its  valves,  impeding  the  reflux  of  the  blood 
along  the  veins. 

"The  second  was  disease  of  the  capillary  vessels,  of  the  minute  arteries,  or 
of  the  minute  veins  of  the  brain  and  its  membranes. 

"  Lastly,  there  were  causes  of  apoplexy  in  the  muscular  efforts,  by  which  the 
action  of  the  heart  itself  was  augmented,  as  in  violent  running,  the  ascent  of  a 
mountain,  &c.,  and  in  other  muscular  efforts,  by  which  the  return  of  venous 
blood  was  impeded,  as  the  efforts  of  vomiting,  or  for  the  expulsion  of  the  faeces; 
and  still  more,  of  parturition. 

"  This  view  of  the  causes  of  apoplexy  would  sufficiently  denote  the  complex- 
ity of  the  problem  of  the  prevention  and  treatment  of  the  apoplectic  and  hemi- 
plegic attack;  for  that  prevention  depended  on  restoring  the  system  to  a  state  of 
what  may  be  termed  equilibrium,  in  regard  to  plethora  and  inanition;  to  the 
removal  of  irritating  or  morbid  matters  from  the  primae  viae;  to  the  correction  of 
the  morbid  diathesis  in  dyspepsia,  gout,  and  cachexia.  The  prescription  must 
include  remedies  and  regimen  to  meet  all  these  circumstances,  and,  as  he  had 
stated,  the  problem  was  by  no  means  either  an  easy  or  a  simple  one.  Yet  ano- 
ther element  in  the  problem  was  that  which  related  to  the  local  or  topical  reme- 
dies. On  each  of  these  sources  of  the  apoplectic  and  hemiplegic  attack,  he 
proposed  to  make  a  few  observations.  These  observations  would  be  principally 
addressed  to  the  medical  practitioner;  but  as  far  as  they  might  relate  to  regimen, 
they  might,  he  thought,  be  profitably  considered  by  the  patient. 

*»(I).  Of  plethora^  or  fulness. — This  cause  of  the  apoplectic  or  hemiplegic 
seizure  was  that  which  had  received  most  attention,  or  rather  it  was  that  towards 
which  medical  opinion  was  most  biassed,  not  to  say  prejudiced.  It  was  unne- 
cessary for  him  to  describe  the  symptoms  of  this  condition  so  well  known. 
The  most  satisfactory  mode  of  treatment  was  to  open  a  vein  and  allow  the  blood 
to  flow  from  an  ample  orifice,  the  patient  being  placed  in  the  perfectly  erect 
position,  until  incipient  syncope  was  induced;  the  quantity  of  blood  which  thus 
flowed  was  the  diagnosis  and  measure  of  the  disease  in  every  respect.  If  the 
patient  were  young  and  robust,  if  the  plethora  were  decided,  and  especially  if 
there  were  real  congestion  and  no  laceration  of  the  brain,  a  large  and  proportion- 
ate quantity  of  blood  would  flow  before  the  slightest  degree  of  syncope  was 


1842.]  Medical  Pathology  and  Therapeutics.  453 

manifested.  No  other  measure  afforded  at  once  such  security  to  the  patient, 
and  such  information  to  the  physician.  It  was  impossible  for  him  to  speak  in 
too  high  terms  of  the  advantage  of  this  measure  in  both  these  respects.  In 
reference  to  blood-letting,  there  was  this  important  question,  Was  the  case  one 
of  congestion  or  pressure,  or  was  there  actual  hemorrhage  with  laceration  of  the 
substance  of  the  brain?  In  the  former  case,  much  blood  would  flow  before  inci- 
pient syncope  occurred,  and  much  might  be — must  be  taken;  but  in  the  latter  the 
injury  had  inflicted  a  shock  upon  the  system,  and  little  blood  flowed  before  syn- 
cope appeared;  and  even  the  loss  of  that  little  was  difficultly  borne.  To  take 
more  would  be  death!  It  might  be  said  that  we  ought  to  distinguish  the  two 
cases  a  priori.  He  replied  in  the  words  of  Celsus,  '  Id  votum  est.'  Turgidity 
and  flushing  denoted  congestion,  and  pallor  and  collapse  might  denote  lacera- 
tion. But  many  cases  occurred  in  which  nothing  so  marked  was  observed;  and 
in  these,  in  the  absence  of  an  earlier  and  more  perfect  diagnosis,  he  knew  by 
experience,  that  the  plan  of  instituting  blood-letting  proposed,  afforded  most 
important  and  salutary  information,  leading  us  on  to  take  more  blood  in  the  case 
in  which  greater  depletion  was  required,  and  checking  our  depletion  in  those  in 
which  it  would  not  be  either  well  borne  or  remedial.  But  having  made  and 
repeated  this  statement  on  other  occasions,  and  the  profession  being,  he  believed, 
well  acquainted  with  it,  he  proceeded  at  once  to  another  topic. 

"  (2.)  Of  inanition. — It  was  constantly  his  lot  to  see  patients  who  were  in 
jeopardy  not  from  fulness  but  from  inanition,  and  who  had  long  been  kept  in  a 
state  of  anaemia  by  blood-letting,  general  or  topical,  when  an  opposite  treatment 
was  required  to  restore  the  equilibrium  of  the  system,  and  to  remove  the  vertigo 
and  other  symptoms  threatening  an  attack  of  apoplexy.  A  state  of  pallor,  a  dis- 
position to  faintishness,  palpitation  and  nervous  timidity,  the  occurrence  of  the 
symptoms  when  the  stomach  was  empty,  when  the  bowels  had  been  relieved, 
and  on  suddenly  looking  upwards,  or  resuming  the  upright  position  on  rising 
from  bed,  or  after  stooping,  or  the  recumbent  position.  Such  were  the  diagnos- 
tic signs  of  a  state  of  inanition  from  a  state  of  plethora.  The  history  of  the  case 
also  afforded  a  diagnosis;  for,  although  depletion  might  have  appeared  to  afford 
a  momentary  relief  o(  the  symptoms,  it  had  ensued  in  their  aggravation  in  gene- 
ral. An  opposite  mode  of  treatment,  very  cautiously  and  prudently  adopted  and 
pursued,  would  confirm  the  diagnosis,  by  affording  a  more  permanent,  though, 
possibly  a  less  immediate  and  marked  relief.  It  was  to  the  important  distinc- 
tion between  the  immediate  and  permanent  relief,  indeed,  that  he  would  draw 
the  attention  of  the  profession.  In  the  case  of  symptoms  portending  apoplexy 
or  hemiplegia,  although  these  might  arise  from  inanition,  yet  they  were  inva- 
riably relieved  by  depletion,  although  they  afterwards  returned  with  augmented 
force.  This  effect  was  very  puzzling  to  the  inexperienced  practitioner.  It  was 
explained  by  the  fact  that  the  symptoms  ceased  under  the  influence  of  a  condi- 
tion allied  to  syncope,  but  returned  with  the  reaction.  This  subject  must  be 
carefully  studied,  in  order  that  the  nature  and  treatment  of  the  case  might  be 
understood.  He  had  next  particularly  to  notice  that  the  state  of  anaemia  was 
not  one  of  safety.  In  such  circumstances,  apoplexy  and  hemiplegia,  with 
the  actual  effusion  of  blood  into  the  cerebrum,  had  occurred.  Such  a  case  was 
related  by  the  late  Dr.  Denraan.  It  occurred  in  the  midst  of  exhaustion  and 
anaemia  from  protracted  uterine  hemorrhage:  a  clot  of  blood  was  found  in  the 
cerebrum.  A  similar  case  was  detailed  by  Mr.  Travers.  This  latter  occurred 
under  the  actual  use  of  the  lancet,  and  during  the  flow  of  blood  from  the  arm. 
A  third  case  occurred  to  Mr.  Hammond,  of  Brixton,  after  parturition.  The 
patient  was  attacked  with  hemiplegia;  she  gradually  recovered.  We  might 
therefore  incautiously  bleed  our  patients  into  apoplexy  and  hemiplegia!  This 
statement  should  lead  us  to  be  very  wary  in  the  use  of  this  remedy  in  doubtful 
or  protracted  cases.  Even  in  cases  of  injury  of  the  brain,  as  in  concussion,  the 
same  question  presented  itself.  This  point  was  admirably  illustrated  by  the  fol- 
lowing remark  of  Sir  Benjamin  Brodie: — '  Where  bleeding  has  been  carried  to 
a  great  extent,  symptoms  frequently  occur  which  in  reality  arise  from  the  loss 
of  blood,  but  which  a  superficial  observer  will  be  led  to  attribute  to  the  injury 


454  Progress  of  the  Medical  Sciences,  [Oct. 

itself,  and  concerning  which,  indeed,  it  is  sometimes  difficult  even  for  the  most 
experienced  surgeon  to  pronounce,  in  the  first  instance,  to  which  of  these  two 
causes  they  are  to  be  referred.  Repeated  copious  blood-letting  is  of  itself  ade- 
quate to  produce  a  hardness  of  the  pulse,  which  we  shall  in  vain  endeavour  to 
subdue  by  persevering  in  the  same  system  of  treatment.  In  many  individuals  it 
will  produce  headache  and  confusion  of  mind,  not  very  different  from  what  the 
injury  itself  had  previously  occasioned.'  The  pallor  of  the  countenance,  the 
effects  of  position,  the  effects  of  fasting,  or  of  an  active  purgative,  the  history 
of  the  case,  must  be  carefully  considered  in  forming  our  diagnosis.  The  treatment 
would  then  consist  in  carefully  restoring  the  system  to  its  state  of  equilibrium. 

"  (3.)  Of  Dyspepsia  and  Cachexia. — There  could  be  little  doubt  that  in  dys- 
pepsia the  blood  itself  became  contaminated,  and,  as  it  were,  cachectic.  On  this 
principle  we  accounted  for  the  appearance  of  furunculus  and  paronychia;  for  the 
morbid  condition  of  the  tongue  and  interior  of  the  mouth,  the  general  cutaneous 
surface,  the  secretions,  &c.  He  had  so  often  observed  symptoms  threatening 
the  apoplectic  or  hemiplegic  attack,  in  conjunction  with  symptoms  of  dyspep- 
sia and  cachexia,  that  he  had  no  doubt  of  the  vast  importance  of  a  strict  atten- 
tion to  this  subject.  That  very  day,  (Oct.  1,  1841,)  he  had  been  consulted  by 
a  medical  gentleman  from  Birmingham  under  these  circum'stances.  One  form 
of  this  affection  was  the  following: — vertigo  occurred  with  faintishness,  sickish- 
ness,  and  a  cold  clammy  perspiration;  sometimes  there  was  actual  sickness, 
sometimes  much  flatus.  In  these  cases  the  feet  and  other  extreme  parts  were 
apt  to  be  cold.  The  secretion  of  the  liver  was  frequently  defective,  and  the 
urine  was  apt  to  deposit  the  lithic  acid  salts.  Nothing  could  be  so  injurious  as 
blood-letting.  In  no  case  was  the  loss  of  blood  repaired  with  such  difficulty. 
The  application  of  a  few  leeches  frequently  left  a  state  of  debility  and  pallor 
which  were  felt  and  seen  for  weeks.  The  treatment  consisted  in  the  correction 
of  the  secretions,  and  in  the  infusion  of  tone  and  general  health  into  the  system. 
The  compound  decoction  of  aloes,  the  infusion  of  rhubarb,  of  gentian,  of  cin- 
chona, singly,  or  better,  mixed  together;  sarsaparilla,  the  vinum  ferri,  the  bicar- 
bonate of  potass;  stomachics,  tonics,  and  antacids,  in  a  word,  were  the  principal 
internal  remedies.  But  with  these,  a  mild,  nutritious  diet,  a  system  of  gentle 
exercises,  early  hours,  the  tepid  salt-water  shower-bath,  and  a  strict  attention  to 
the  condition  of  the  feet  and  general  surface,  by  means  of  the  flesh-brush,  flan- 
nel, and  a  frequent  change  of  shoes  and  stockings,  should  be  conjoined.  Those 
engaged  in  the  harassing  affairs  of  a  London  life  should  sleep  in  the  country, 
and  cherish  the  utmost  quiet  of  mind. 

"  (4.)  Of  gout. — But  he  had  frequently  traced  a  connection  between  gout  and 
its  frequent  attendant,  the  lithic  acid  diathesis,  and  the  apoplectic  and  hemiple- 
gic seizure.  It  was  not  merely  plethora,  or  the  opposite  state  of  inanition,  which 
led  to  the  apoplectic  attack.  The  morbid  state  of  the  blood  in  dyspepsia  and 
cachexia  also  disposes,  as  he  had  already  said,  to  this  affection.  The  same 
remark  applied  to  the  condition  of  the  system  and  of  the  blood,  especially  in 
gout;  and,  as  he  should  have  to  observe  immediately,  the  same  disposition  ob- 
tained in  several  morbid  conditions  of  the  liver  and  kidney.  A  nobleman,  now 
no  more,  suffered  in  succession  from  gout  and  the  herpes  zoster,  and  the  urine 
deposited  the  lithites  copiously.  He  was  relieved  by  the  appropriate  remedies, 
and  became  affected  with  an  apoplectic  (or  epileptic)  attack.  A  similar  attack 
(without  hemiplegia)  occurred  several  months  afterwards,  and  a  third  attack 
proved  fatal.  This  gentleman  was  pallid,  the  prolabium  being  white.  A  steady 
perseverance  in  such  remedies  as  the  decoctum  aloes  compositura,  the  bicarbo- 
nate of  potass,  and  the  vinum  ferri,  had  in  other  cases  effectually  averted  the 
threatened  evil.  But  he  must  make  another  remark.  The  vinum  colchici  should 
be  given  in  very  minute  doses,  as  five  drops  thrice  a-day,  also  steadily  and  per- 
severingly,  to  overcome  the  specific  gouty  diathesis.  The  lithic  acid  diathesis 
was  not  the  only  urinary  disorder  which  led  to  apoplexy  and  hemiplegia.  This 
attack,  it  was  well  known,  occurs  in  the  case  of  diabetes  and  in  that  of  albumi- 
nous urine.  Although  he  had  designated  the  attack  apoplectic  and  hemiplegic, 
it  was  sometimes  more  allied  to  epilepsy  than  apoplexy.     The  gentleman  to 


1842.]  Medical  Pathology  and  Therapeutics.  455 

whose  case  he  had  briefly  adverted,  was  affected  with  minute  ecchymosed  spots 
on  the  forehead,  which  he  had  only  observed  under  three  circumstances,  viz., 
after  severe  vomiting-,  the  effects  of  parturition,  and  the  epileptic  attack;  when 
he  saw  him,  soon  after  the  second  seizure,  the  insensibility  had  passed  away, 
and  there  was  no  hemiphlegia. 

"  (5.)  Of  disease  of  the  heart. — It  had  long  been  supposed  that  disease  of  the 
heart  is  a  cause  of  the  apoplectic  seizure,  and  hypertrophy  of  that  organ  had 
been  fixed  upon  as  the  most  influential  in  this  respect.  On  this  question  the 
pathologists  of  France  were  much  divided.  Of  the  two  latest  writers  on  the 
subject,  M.  Andral  was  of  opinion  that  hypertrophy  was  really  a  frequent  cause 
of  apoplexy;  whilst  M.  Louis  was  of  the  opposite  opinion.  There  could  be  no 
doubt  that,  caeteris  paribus,  hypertrophy  of  the  heart  would  co-operate  in  induc- 
ing the  apoplectic  attack;  but  he  thought  that  a  much  more  energetic  cause  of 
apoplexy,  and  of  congestion  and  hemorrhage  in  general,  was  that  forni  of  disease 
which  impeded  the  return  of  the  venous  blood  from  the  brain,  vii.^  dilatation 
and  valvular  disease.  The  worst  form  of  hypertrophy  might  be  unattended  by 
symptoms  or  appearances  of  congestion;  but  no  severe  case  of  dilatation  or  of 
valvular  disease  ever  existed,  without  lividity  of  the  countenance,  dozing,  and 
other  appearances  and  symptoms  of  apoplectic  tendency.  Altogether,  however, 
we  wanted  a  series  of  cases,  carefully  taken  and  analyzed, 'and  statistically 
given,  to  establish  the  truth  of  the  real  influence  of  disease  of  the  heart  in  induc- 
ing the  really  apoplectic  seizure. 

"(6.)  Diseases  of  the  capillary  and  minute  vessels. — The  influence  of  this  cause 
of  apoplexy  was  placed  beyond  question  by  post-mortem  examination.  Some- 
times the  morbid  appearance  was  a  dilated  condition  of  the  capillaries;  some- 
times an  ossified  condition  of  the  minute  arteries  (]);  sometimes  a  minute 
aneurism.  Another  important  topic  was  that  of  "ramolissement,"  or  softening 
of  the  brain,  as  the  cause,  and  as  the  effect  of  the  apoplectic  or  hemiplegic 
seizure.  In  resuming  the  subject  he  might  remark,  that  it  was  not  plethora 
alone  which  predisposed  to  the  apoplectic  and  hemiplegic  attack;  the  very 
opposite  condition  of  the  system,  or  anaemia,  whether  it  arose  from  the  loss  of 
blood  by  blood-letting,  or  hemorrhage,  or  from  defective  sanguification,  was  not 
free  from  this  danger;  dyspepsia  and  cachexia,  as  they  induced  external  disease, 
as  seen  in  furunculus,  paronychia,  &c.,  might  also  induce  a  paralytic  afFectiony 
a  morbid  condition  of  the  blood  taking  the  place  of  plethora  or  anaemia. 

"  0)'  Of  muscular  efforts. — He  might  make  the  same  remark  in  regard  to 
muscular  efforts,  which  he  had  done  in  regard  to  disease  of  the  heart. — those 
efforts  which  opposed  resistance  to  the  reflux  of  the  venous  blood,  were  much 
more  efficient  causes  of  the  apoplectic  seizure  than  those  efforts  which  aug- 
mented the  momentum  of  the  arterial  blood.  Thus,  we  rarely  heard  of  the 
occurrence  of  apoplexy  during  the  violence  of  the  race,  during  the  ascent  of 
mountains,  &c.,  but  such  an  occurrence  at  the  water  closet  was  by  no  means 
uncommon;  and  we  all  knew  how  apt  the  parturient  efforts  were  to  induce  con- 
gestion of  the  brain,  and  the  consequent  apoplectic  seizure.  It  would  be  most 
interesting  to  correct  our  ideas  on  these  subjects  by  a  cautious  appeal  to  facts. 

"  Dr.  Hall,  in  reply  to  a  question,  detailed  a  case  in  which  the  symptoms 
threatened  apoplexy.  The  patient  had  been  bled  much  and  purged,  was  pallid, 
and  there  was  a  bruit,  as  from  loss  of  blood,  perceptible.  The  patient  was 
worse  before  breakfast  than  after  dinner,  and  could  not  look  up.  He  recovered 
under  the  employment  of  mild  chalybeates.  This  was  an  extreme  case;  there 
wpre  many  of  an  intermediate  character.  Dr.  Hall  also  expressed  his  opinion 
that  the  skull  always  contained  the  same  quantity,  but  the  blood  might  be  occa- 
sionally more  serous,  and  give  rise  to  a  pallid  condition  of  the  brain;  but  in  this 
state,  rupture  and  effusion  might  take  place." — Lond.  andEdin.  Month.  Journ.^ 
Aug.  1842. 

17.  Quantity  of  Blood  within  the  Cranium. — Mr.  Jolly  maintains,  from  consi- 
derable experience,  that  no  fact  can  be  more  clearly  established,  than  that  the 


456  Progress  of  the  Medical  Sciences.  [Oct. 

brain  is  an  elastic,  and,  therefore,  compressible  organ,  and,  of  course  might  con- 
tain more  blood  at  one  time  than  at  another. — Ibid. 

18.  Blood  in  the  Brains  of  Animals  bled  to  death. — Mr.  Crisp  states  that  he  last 
year  made  a  series  of  experiments  with  the  view  of  determining-  the  condition 
of  the  brain  of  animals  bled  to  death.  The  result  was  quite  different  from  that 
stated  by  Dr.  Kelly,  of  his  experiments  performed  for  a  similar  purpose.  Dr. 
Kelly  found  the  brain  always  full  of  blood,  while  he,  on  the  contrary,  had  found 
it  to  be  bloodless;  nor  could  he  discover  any  corresponding  quantity  of  serum  to 
make  up  the  deficiency.  Mr.  Crisp's  experiments  consisted  in  killing  dogs  and 
rabbits,  by  dividing  the  carotid  artery.  The  brains  of  the  same  kind  of  animals 
killed  by  poison,  and  other  means,  presented  a  very  different  appearance. — Ibid. 

19.  Belladonna  in  Epilepsy/. — Dr.  Debreyne,  lecturer  on  practical  medicine  at 
Le  Grande  Trappe,  Orne,  has  published  a  resume  of  his  experience  of  the  treat- 
ment of  epilepsy  for  the  last  twenty-five  years,  in  the  cases  that  have  occurred 
under  his  charge,  in  which  he  gives  the  decided  preference  to  belladonna  as  a 
therapeutic  agent.  He  says  that,  having  tried  in  vain  valerian,  orange  leaves, 
white  oxyde  of  zinc,  the  meadow  narcissus,  the  ammoniaco-sulphate  of  copper, 
the  nitrate  of  silver,  Meglin's  pills,  the  cyanuret  of  potassium,  the  croton-tig- 
lium,  not  used  as  a  drastic  purgative,  but  as  an  anti-epileptic,  he  was  induced  to 
have  recourse  to  belladonna,  by  the  perusal  of  a  case  published  by  Stoll  in  his 
Batio  Medendi,  pars  iii.  p.  217.  Of  the  other  medicines  mentioned  above,  he 
derived  the  greatest  advantage  from  the  oxyde  of  zinc,  the  nitrate  of  silver,  and 
the  valerian. 

Dr.  Debreyne  has  used  the  belladonna  extract  in  about  two  hundred  cases  of 
epilepsy  during  the  last  twenty-five  years,  and  he  says  there  had  been  scarcely 
one  in  which  its  use  was  not  attended  with  advantageous  results.  Generally 
speaking,  the  fits  have  been  diminished  in  intensity,  and  have  occurred  less 
frequently,  or  have  been  altogether  suspended  for  weeks,  months  or  even 
years.  Cases  have  occurred  where  the  fits  used  to  come  on  every  month  or  week, 
or  even  several  times  in  the  week,  but  where,  under  the  influence  of  the  bella- 
donna, they  have  been  suspended  for  six  months,  and  even  for  one,  two,  or  more 
years.  Some  patients  have  asserted  that  they  had  not  had  a  relapse  for  seven, 
eight,  or  nine  years.  In  all  cases  where  the  attack  comes  on  with  the  pre- 
monitary  aura.  Dr.  Debreyne  furnishes  his  patients  with  a  small  bottle  of  liquid 
ammonia,  to  arrest  the  coming  attack.  The  more  frequent  the  fits  are,  the 
more  readily  is  the  complaint  influenced  by  the  belladonna;  but  when  they 
occur  only  once  every  four,  five  or  six  months,  it  is  much  more  difficult  to  modify 
them — that  is,  to  diminish  them  in  intensity,  or  to  suspend  them  altogether. 
In  such  cases  the  remedy  should  be  administered  some  time  previous  to  the 
presumed  epoch  of  the  nearest  attack.  At  the  same  time  it  must  be  observed 
that  belladonna'  is  by  no  means  a  specific  in  epilepsy;  in  fact,  cases  would 
occasionally  occur  in  which  the  severity  of  the  fit  would  be  for  a  time  much 
diminished,  or  the  attack  altogether  suspended,  and  yet,  after  the  lapse  of  a 
certain  period,  the  remedy  would  become  altogether  powerless.  In  such  a  case 
no  other  medicine  was  found  of  service.  The  cases  of  epilepsy  spoken  of 
throughout  by  Dr.  Debreyne,  are  of  course  cases  of  the  disease,  when  it  occurs 
independent  of  lesion  of  structure;  but,  he  adds,  that  in  symptomatic  epilepsy 
if,  after  the  removal  of  the  cause,  the  fits  should  still  recur  by  a  sort  of  habit  of 
the  nervous  system,  the  belladonna  might  be  had  recourse  to,  and,  should  it  fail, 
the  quinia  alone,  or  combined  with  valerian,  might  be  ordered.  The  mode'of 
administration  of  the  belladonna  is  as  follows: — Four  scruples  of  the  watery 
extract  of  belladonna  are  mixed  with  two  of  powdered  gum  arable,  and  a  suflH- 
cient  quantity  of  any  inert  powder  to  make  120  pills,  one  of  which  is  given  the 
first  day,  two  the  second,  the  dose  being  gradually  increased  to  six  in  the 
twenty-four  hours,  although  it  may  be  raised  to  eight  or  nine  pills  taken  daily, 
if  disordered  vision,  or  other  symptoms  of  the  injurious  effects  of  belladonna,  do 
not  show  themselves.   In  that  case  the  dose  must  be  diminished,  or  omitted  alto- 


1842.]  Medical  Pathology  and  TTierapeuHcs,  457 

gether  for  several  days. — Frov,  Med.  Journ.,  July  2,  1842,  from  Bull,  de  Thera- 
peutique. 

20.  Nature  and  Treatment  of  Scrofula. — After  enumerating  the  different  forms 
of  scrofulous  cachexia,  Dr.  Roesch  arrives  at  the  conclusion  that  scrofulous 
affections  are  produced  by  an  excess  of  acid  matters  in  the  fluids  of  the  body. 
Agreeing  vi'ith  the  ancient  physicians  in  his  theory  of  the  disease,  he  recom- 
mends their  plan  of  treatment,  viz.  absorbents,  alkalies,  and  fat  or  oily  matters. 
He  says  he  has  observed  that,  in  those  countries  vi^here  the  children  get  a  quan- 
tity of  lard  and  other  fat  matters  witli  their  food,  that  scrofula  is  extremely  rare. 
Cod-liver  oil,  is  therefore,  according  to  him,  one  of  the  most  suitable  remedies 
to  administer  in  this  disease,  seeing  it  possesses  the  rare  properties  of  being  at 
once  a  stimulant,  aroborant,  an  antacid,  and  nutrient.  He  considers  that  the  iodine 
in  it  will  have  a  very  secondary  effect,  the  other  properties  of  the  oil  being  the  most 
valuable. — Ed.  Med.  and  Surg.  Journ.,  July  1842,  from  Haeser''sArchiv.,  Oct.  1841. 

21.  State  of  the  Blood  in  Hydrophuhia. — The  last  number  of  the  Austrian  Yahr- 
hilcher  contains  an  interesting  case  of  hydrophobia,  with  an  account  of  some  ex- 
periments performed  by  Professor  Berres  on  the  patient's  blood. 

The  blood  was  dark  red  in  colour,  and  of  an  oily  feel;  with  the  exception 
of  the  portion  contained  in  the  heart,  it  furnished  very  little  fibrin  and  did  not 
coagulate.  When  examined  under  the  microscope,  the  globules  appeared  as 
perfectly  round  corpuscles  of  a  dull  white  colour,  without  any  nucleus,  and 
with  a  few  dentated  red  rays  along  the  edges. 

The  bicarbonate  of  potass  developed  the  red  coloured  rays  on  the  corpuscles; 
the  same  effect  was  produced  more  evidently  by  a  concentrated  solution  of  sul- 
phate of  copper,  and  the  nuclei  now  appeared. 

On  washing  the  corpuscles  with  water,  they  became  of  a  dull  white  colour, 
and  seemed  to  pass  gradually  into  a  gelatinous,  granular  mass  of  molecules. 

Concentrated  acetic  acid  turned  the  corpuscles  into  molecules.  At  first,  each 
globule  changed  into  a  cluster  of  small  granules,  which  soon  separated,  thus 
showing  the  difference  between  them  and  the  globules  of  healthy  blood. 

Under  a  solution  of  chlorine  the  globules  remained  transparent,  but  soon 
changed  into  a  granular  mass.  When  concentrated  muriatic  acid  was  mixed 
with  a  few  drops  of  the  blood,  a  considerable  quantity  of  gas  was  disengaged, 
and  the  corpuscles  were  converted  as  before  into  molecules,  with  a  few  opaque, 
contracted  globules  mixed  amongst  them. 

Treated  with  concentrated  nitric  acid  the  globules  became  small,  round,  and 
opaque;  some  few  were  oblong;  some  pointed  at  both  ends. 

Sulphuric  aether,  iodine,  and  corrosive  sublimate  were  also  employed  with 
analogous  effects.  The  action  of  water,  chlorine,  acetic  and  muriatic  acids,  was 
altogether  different  from  that  produced  on  healthy  blood;  the  three  first  sub- 
stances rapidly  changing  the  corpuscles  into  molecules,  and  the  latter  disen- 
gaging a  remarkable  quantity  of  gas.  The  peculiarities  then  observed  in  the 
blood  in  this  case  may  be  stated  to  be — dull  white  globules,  without  nuclei;  no 
appearance  of  thecrenated  margin;  a  very  quick  transition  of  the  corpuscles  into 
molecules,  and  a  tendency  to  lose  their  individual  character. — Frov.  Med.  Journ., 
July  2,  1842. 

22.  Disease  of  the  Kidney. — Dr.  Barlow  has  narrated  a  series  of  interesting 
cases  illustrative  of  the  following  points: — First,  that  there  is  a  certain  symptom 
connected  with  irritation  of  the  kidney,  and  which,  although  not  confined  to  it 
alone,  is  not  necessarily  connected  with  disease  of  those  structures  whose  affec- 
tions are  most  likely  to  be  confounded  with  those  of  the  kidneys,  so  that  when 
this  symptom  is  absent,  we  may  eliminate,  and  thereby  disembarrass  ourselves 
of  the  consideration  of  all  such  affections  of  the  kidneys  as  would  necessarily 
be  attended  by  irritation  of  that  organ;  and  when  this  symptom  is  present, 
we  are  furnished  with  a  reason  for  assigning  the  seat  of  the  disease  to  the 

No.  VIII.— October,  1842.  39 


458  Progress  of  the  Medical  Sciences,  [Oct. 

kidney,  in  preference  to  several  adjacent  structures.     The  symptom   is  sick- 
ness, or  irritability  of  stomach. 

Secondly,  and  further,  there  is  a  certain  symptom,  or  rather,  set  of  symptoms, 
dependent  on  the  non-depuration  of  the  blood  by  the  kidney,  whether  this  non- 
depuration  be  the  result  of  mechanical  obstruction  to  the  flow  of  the  urine,  of  a 
diminution  in  its  quantity,  or  of  a  depraved  condition  of  that  secretion,  in  which 
its  most  important  ingredients  are  wanting — viz.,  cerebral  disorder  of  a  peculiar 
character. 

There  are,  however,  several  affections  of  the  kidney  which  do  not  necessarily 
give  rise  to  irritation  of  that  organ,  and  in  which  the  sickness  may  not  be  present 
to  aid  our  diagnosis;  of  these,  the  principal  are  the  granular  degeneration,  sup- 
puration, and  perhaps  some  forms  of  adventitious  or  malignant  deposit. 

In  the  first  of  these,  the  disease,  depending  in  the  first  place  probably  upon 
congestion,  and  afterwards  upon  a  chronic  change  in  the  structure  of  the  organ, 
irritation  is  not  a  necessary  concomitant,  although  the  disease  may,  and  no  doubt 
frequently  does,  result  from  irritation,  giving  rise  to  chronic  inflammation; 
accordingly,  we  find  that  sickness  is  always  present,  although  it  is  sometimes 
a  most  troublesome  symptom.  In  suppuration  we  should  generally  have  irrita- 
tion, giving  rise  to  sickness,  in  the  first,  instance,  and  probably,  at  a  later  period, 
obstructed  function,  with  its  concomitant  changes  in  the  urine,  and  cerebral  dis- 
order, with  probably,  at  some  time,  the  presence  of  pus  in  the  urine. 

With  regard  to  malignant  disease,  it  is  very  probable  that  this  deposit  taking 
place,  as  has  been  remarked  by  Dr.  Bright,  in  the  cellular  membrane  connecting 
the  firm  parts  of  various  structures,  the  parts  of  the  organ  in  which  this  deposit 
takes  place  may  be,  as  it  were,  pushed  aside,  without  suffering  any  mechanical 
violence  or  functional  disturbance;  at  the  same  time,  it  is  also  probable  that,  in 
the  progress  of  distension  to  which  this  organ  is  subjected,  some  slight  lacera- 
tion, or  irregular  pressure,  giving  rise  to  irritation,  will  sooner  or  later  occur, 
and  accordingly  some  sudden  invasion  of  sickness  almiOSt  uniformly  happens 
bei'ore  such  deposit  in  the  kidney  has  produced  a  tumour  of  any  considerable  size. 
"We  should  also  in  this  case,  probably,  have  some  degree  of  haematuria,  espe- 
cially if  the  disease  be  of  a  fungoid  character,  the  most  common  form  of  malig- 
nant deposit  in  the  kidney. 

Irritability  of  the  stomach  is  not  to  be  regarded  as  pathognomonic  of  disease 
of  the  kidney;  but  in  cases  where  doubts  arise  as  to  whether  any  disease  is  to 
be  referred  to  the  kidney,  or  some  neighbouring  organ,  the  absence  or  presence 
of  sickness  will  go  far  to  decide  the  question;  and  further,  in  cases  not  unfre- 
quently  *met  with,  where  the  prominent  symptom  is  distressing  and  obstinate 
sickness  without  any  assignable  cause,  especial  attention  should  be  directed  to 
the  kidneys,  and  every  means  used  to  determine  the  state  of  those  organs.  The 
same  observations  will  apply  very  nearly  to  the  second  class  of  symptoms — 
namely,  the  cerebral  disorder;  for  as  yet  we  want  sufficient  evidence  to  prove 
that  similar  derangement  of  the  function  of  the  brain  may  not  be  produced  by 
other  causes.     The  cases  narrated  are  nine  in  number. — Ibid. 

23.  Simple  and  Double  Pneumo-Thorax. — Dr.  Puchelt,  Jr.,  relates  in  the 
Medicinische  Annalen,  a  case  of  double  pneumo-thorax,  and  oflTers  the  following 
conclusions. 

1st,  The  duration  of  a  case  of  double  pneumo-thorax  is  much  shorter  than 
one  of  simple.  In  the  first,  it  may  last  for  a  few  days;  in  the  second,  for  some 
months,  or  even  for  a  year. 

2d^  The  commencement  of  pneumo-thorax  is  characterized,  in  general,  by  a 
sudden  pain  in  the  affected  side,  and  by  great  dyspncea.  However,  both  of 
these  symptoms  may  be  wanting. 

3d,  The  pain  in  the  side,  which  takes  place  during  the  course  of  the  disease, 
may  become  very  violent.     It  is  a  pleuritic  pain. 

Aih,  In  the  double,  the  general  state  of  the  patient  is  less  marked  by  col- 
lapse, than  in  the  simple  pneumo-thorax.  It  is  more  distinguished  by  a  sense 
of  suffocation. 


1842.]  Medical  Pathology  and  Therapeutics.  45§ 

5th,  Dyspnoea  is  inseparable  from  the  double,  while  in  the  chronic  pneumo- 
thorax it  is  hardi}^  distinguishable. 

6th,  The  affected  side7  being  dilated,  the  phthisical  appearance  is  effaced, 
which  makes  the  diagnosis  difficult  in  the  double  pneumo-thorax. 

7th,  The  organs  adjacent  to  the  chest  are  displaced,  especially  the  heart  and 
liver. 

8/^,  Percussion  over  the  diseased  side  is  very  clear  and  tympanitic;  it  may, 
however,  be  dull,  and  even  normal  in  some  places. 

9th,  It  is  almost  impossible  to  indicate  the  level  of  the  liquid  by  percussion. 

10th,  The  causes,  according  to  Skoda,  which  give  rise  to  a  sound  sometimes 
tympanitic,  and  sometimes  clear,  depend  on  the  greater  or  less  distension  of  the 
walls  of  the  chest, 

llth.  It  is  not  only  the  air  and  fluid  contained  in  the  chest,  which  modify  per- 
cussion, but  likewise  the  adhesions  existing  between  the  pleura  of  the  lungs  and 
parietes,  and  of  these  again,  with  masses  of  false  membrane. 

I2th,  Metallic  tinkling  is  not  pathognomonic  of  the  disease;  it  is  found  also 
in  large  tuberculous  cavities. 

13/^,  Metallic  tinkling  is  much  more  distinct  in  pneumo-thorax  than  in  tuber- 
culous cavities. 

nth,  In  pneumo-thorax,  it  is  found  most  frequently  in  the  middle,  and  towards 
the  posterior  part  of  the  chest,  and  over  a  great  extent  of  surface;  while  again 
in  a  cavity,  it  is  towards  the  upper  and  anterior  part  of  the  lung,  and  over  a 
much  more  limited  space. 

15th,  There  are  two  kinds  of  metallic  tinkling;  the  one,  ^'' biillaire,^''  resembles 
a  clear  sound  produced  by  the  head  of  a  pin  being  struck  lightly  against  a  thin 
plate  of  metal;  the  other  is  the  metallic  echo  of  the  voice,  cough,  or  rale. 

IQth,  The  '•'•  buUalre'^  metallic  tinkling  is  produced  by  the  passage  of  air 
across  the  pleural  effusion,  (if  the  pulmonary  fistula  opens  below  the  level  of 
the  liquid,)  or  across  the  liquid  found  in  a  perforated  tuberculous  cavity,  (if  the 
opening  in  the  lung  is  below  the  level  of  the  pleural  effusion,)  and  ought  to  be 
attributed  to  the  collision  of  the  fluids  momentarily  separated  by  the  passage  of 
the  air. 

llth.  The  development  of  this  phenomenon  can  only  take  place  when  a  per- 
meable bronchial  tube  opens  into  the  cavity. 

18/A,  The  metallic  echo  is  only  the  simple  resonance  of  the  voice  or  cough  in 
the  pleural  cavity  filled  with  air  and  very  little  fluid. 

19th,  When  the  pulmonary  fistula  opens  above  the  level  of  the  effusion,  and 
the  cavity  with  which  it  communicates  is  small  and  dry,  it  does  not  produce  the 
"6w//axVe"  metallic  tinkling;  and  again,  if  the  bronchial  fistula  is  far  from  the 
periphery  of  the  lung,  the  metallic  echo  is  not  produced. 

SO/A,  The  chemical  analysis  of  the  air  in  the  pleura  communicating  with  the 
bronchi,  contains  very  little  or  no  oxygen,  a  little  carbonic  acid,  and  a  great  deal 
of  nitrogen. — Lond.  and  Edin.  Month.  Journ.,  July,  from  Gaz.  Med.  de  Paris, 
Feb.  12,  1842. 

24.  Influence  of  light  on  the  development  of  the  Small-pox  pustule. — In  a  discus- 
sion at  the  French  Academy  of  Sciences  July  4th,  M.  Serres  stated  that  he  had 
made  numerous  experiments  by  covering  the  small-pox  pustules  with  small  glass 
cups,  and  observed  that  the  pustules  were  developed,  modified  in  their  progress, 
or  completely  arrested,  according  to  the  degree  of  transparency  of  the  glass. 

25.  Urea  secreted  in  large  quantity  by  the  peritoneum  in  a  case  of  Jlscites.-^ 
Prof.  Kane  of  Dublin  has  delected  urea  in  large  quantity  in  the  fluid  drawn  by 
tapping  from  the  abdomen  of  a  woman  affected  wiih  ascites  combined  with  symp- 
toms  of  Bright's   disease  of  the  kidneys. — Dublin  Journal  Med.   Sci.  March, 

1842. 

26.  Nature  and  Treatment  of  siridulous  Convulsion  in  Infants.  By  Marshall 
Hall,  M.  D. — The  disposition  to  this  disease  seems  to  consist  in  a  peculiar  sus- 


460  Progress  of  the  Medical  Sciences.  [Oct. 

ceptibily  of  the  excito-motor  property  of  the  nervous  system.  The  immediate 
attacks  are  the  result  of  the  action  of  sources  of  irritation  or  excitement  of  this 
property.  This  susceptibility  should,  if  possible  be  diminished,  and  the  causes 
of  excitement  should  be  most  carefully  avoided.  These  are  the  two  principles 
which  must,  I  believe,  guide  us  in  our  treatment. 

I.  The  most  obvious  sources  of  irritation  and  excitement  are — 

1.  Dentition.  ' 

2.  Indigestible  food. 

3.  Morbid  alvine  matters. 

4.  External  agents. 

5.  Mental  emotions. 

On  each  of  these  subjects  I  proceed  to  make  a  few  remarks. 

1.  Of  Dentition. — I  have  long  regarded  the  process  of  dentition  as  not  very 
dissimilar  from  a  state  of  sw6-inflammation.  I  have  therefore  prescribed  the 
gum-lancet,  not  only  in  cases  of  actual  dentition,  but  in  cases  in  which  I  did  not 
immediately  expect  the  eruption  of  teeth  through  the  gums,  and  even  in  cases 
in  which  all  the  teeth  had  already  appeared.  From  the  same  motive  I  have  pre- 
scribed scarification  of  the  gums  within  and  without  the  highest  or  lowest  bor- 
der of  the  gums,  or  the  lines  along  which  the  teeth  make  their  appearance. 

I  have  prescribed  the  use  of  this  remedy,  in  a  word,  to  correct  a  state  of  the 
blood-vessels  and  nerves,  which,  though  physiological,  borders  on  a  pathological 
character.  I  have  prescribed  it  to  be  used  daily.  I  have  been  satisfied  with 
nothing  short  of  the  subjugation  of  the  excessive  action  and  fulness  of  the  ves- 
sels, and  of  the  disappearance  of  morbid  actions,  chiefly  of  a  nervous  character, 
in  distant  parts. 

I  have  thought  it  right  to  continue  the  remedy,  even  when  these  effects  have 
been  produced,  knowing,  by  painful  experience,  how  apt  they  are  to  recur.  I 
have  considered  that  an  infant  had  better  have  its  gum  lanced  a  thousand  times 
unnecessarily  even,  than  be  subjected  to  one  convulsive  attack.  I  have  com- 
pared the  operation  on  the  gum  with  the  morbid  effect  of  a  convulsion  on  the 
brain. 

My  prescription  has  been  met  by  opposition,  but  by  no  argument;  by  fore- 
bodings of  terrible  ulceration,  and  even  mortification  of  the  gums,  but  by  no 
such  occurrence. 

In  one  word,  I  believe  we  have  still  to  learn  the  measure  and  extent  of  the  ad- 
vantage to  be  derived  from  the  full,  free,  and  daily  scarification  of  the  gums 
during  the  process  of  dentition. 

Interesting  questions  to  determine  would  be — first,  whether  the  temperature 
is,  as  is  alleged,  augmented  during  dentition;  and,  secondly,  whether  this  ele- 
vated temperature  be  reduced  by  the  use  of  the  scarificator.  It  is  well  known 
that  the  new  horn  of  the  deer  is  extremely  hot  during  its  rapid  growth.  It  is 
well  known  that  frequent  scarification  of  the  conjunctiva  reduces  the  actual  in- 
flammation of  that  membrane. 

2.  Of  Indigestible  Food. — The  repetition  of  the  attack  of  crowing  convulsion 
has  so  often,  within  my  own  experience,  been  the  result  of  improper  and  indi- 
gestible food,  that  I  invariably  fix  upon  some  one  article  or  kind  of  diet,  of  the 
most  unquestionable  character,  to  the  exclusion  of  all  others.  In  the  case  upon 
which  these  remarks  are  based,  I  desired  that  a  young  and  healthy  nurse  might 
be  procured,  and  that  no  other  kind  of  diet  might  be  allowed.  We  were  fortu- 
nately successful  both  in  our  choice  of  a  nurse  and  in  the  result  of  our  experi- 
ment, and  to  this  day  the  little  patient  has  taken  no  food  except  the  nurse's  milk. 

In  other  instances,  when  the  child  was  too  old  for  a  nurse,  I  have  recommend- 
ed asses'-milk,  or  a  certain  proportion  of  cow's-milk  and  water,  thickened  with 
rusk  or  arrow-root,  and  taken  through  a  "  bottle,"  as  the  sole  diet. 

In  the  case  of  the  threatening  of  an  attack,  I  have  directed  the  fauces  to  be 
tickled  by  a  feather,  and  the  stomach  to  be  thoroughly  evacuated  by  vomiting. 

3.  Of  the  state  of  the  Boivels.— The  bowels  should  be  well  moved  daily.  But 
in  accomplishing  this,  we  must  avoid  all  irritating  measures,  which  may  them- 


1842.]  Medical  Pathology  and  Therapeutics,  461 

selves  induce  the  attack,  and  exhaustion,  which  adds  to  the  susceptibility  to 
attacks. 

If  the  secretions  be  wrong-,  a  grain  of  calomel  or  blue  pill  should  be  given 
frequently.  Larg-e  doses  of  calomel  are,  I  am  persuaded,  injurious.  They  are 
the  source  of  much  irritation  first,  and  of  much  exhaustion  afterwards.  The 
mildest  effectual  aperients  are  next  required.  The  infusion  of  rhubarb,  with  the 
tartrate  of  potass  and  manna,  is  one  of  these.  To  such  a  draught  a  ievv  drops 
of  the  tincture  of  hyoscyamus,  of  the  aromatic  spirits  of  ammonia,  and  a  little 
of  the  syrup  of  ginger,  may  be  added.  But  a  most  important  remedy  is  the 
enema  of  warm  water  or  barley-water.  To  be  administered  in  sufficient  abun- 
danire,  this  must  be  given  very  slowly.  It  is  tlien  most  effectual,  washing  out 
the  intestine,  and  removing'  what  even  drastic  purgatives  would  leave  behind. 

It  frequently  happens  that,  in  the  crowincr  disease,  there  is  a  spasm  of  the 
gall-ducts,  and  the  alvine  evacuation  is  as  pale  as  white  clay.  Nothing  removes 
this  state  of  things  so  effectually  as  the  repeated  use  of  an  ample  lavement.  It 
has  accomplished  more  than  the  blue  pill,  the  g-ray  powder,  or  calomel  itself,  I 
shall  never  forget  the  surprise  of  a  friend  of  mine,  who  had  brought  his  child  to 
me,  sayinjg,  "all  my  remedies  have  failed  in  inducing  the  due  flow  of  bile."  1 
said,  "omit  all  medicines,  and  give  an  ample  lavement  night  and  morning."  In 
three  days  the  desired  event  was  accomplished.  I  have  already  suggested  the 
propriety  of  avoiding  the  irritation  of  purgative  medicine  by  adding  the  hyos- 
cyamus. 

4.  External  Agents. — The  principal  of  the  external  agents  which  influence 
this  disease,  both  injuriously  and  heneficially,  is  the  external  atmosphere.  The 
baneful  influence  of  the  northeast  wind,  and  the  curative  influence  of  change  of 
air,  and  especially  of  the  sea-breezes,  are  not  less  marked  in  this  affection  than  in 
hooping-cough;  facts  which,  with  many  others,  denote  an  intimate  relation  be- 
tween these  two  diseases. 

When  the. little  patient  has  been  long-  free  from  attacks,  a  sudden  change  of 
the  wind  to  the  northeast  frequently  induces  a  return  of  them;  and  when  they 
have  been  long  obstinately  repeated,  and  have  become,  as  it  were,  chronic,  a 
change  of  air  has  induced  as  suddenly  a  suspension  of  them. 

An  interesting  remark  is  made  by  Sir  Henry  Marsh  (Dublin  Hospital  Re- 
ports, vol.  v.,  p.  610).  Speaking  of  a  little  patient  affected  with  this  disease, 
he  observes:  "About  this  period  a  slighter  recurrence  of  these  symptoms  led  lo 
the  removal  of  the  child  from  the  city  to  the  country,  upon  which  they  ceased 
immediately,  and  the  child  improved  rapidly  in  health  and  strength.  Recovery 
appeared  now  so  complete,  that  the  child  was  brought  back  to  a  large  and  new- 
ly-painted house  in  the  city;  when,  after  a  few  hours,  the  spasmodic  attacks 
recurred  with  violence.  On  a  second  removal  to  the  country  they  ceased  at 
once;  a  similar  experiment  was  a  second  lime  tried,  and  with  precisely  similar 
results;  and  it  is  a  curious  fact  two  other  children  were  attacked  with  a  similar 
spasmodic  affection  in  this  same  newly-painted  house:  of  these,  one  died  in  a  con- 
vulsion; the  other,  on  being  sent  to  the  country,  recovered.  The  chiid,  whose 
case  has  just  been  related,  had  been  for  years  free  from  any  spasmodic  affection, 
but  remains  delicate,  and  suffering  severely  from  scrofulous  disease-" 

These  observations  are  sufficient  for  my  present  purpose,  and  I  proceed  to  make 
a  remark  or  two  on  the  effects  of 

5.  Menial  Emotion. — Even  in  infants,  mental  irritation  is  a  frequent  cause  of 
convulsive  attacks.  The  infant  should  not  be  suddenly  awaked  out  of  sleep. 
The  infant  should  not  be  "  slapped"  by  an  angry  nurse.  K  the  nursing  nurse 
be  out  of  temper,  there  is  frequently  a  double  source  of  renewed  malady;  her 
treatment  of  the  infant  is  rude,  and  her  milk  unwholesome.  To  change  the 
nurse  is,  therefore,  occasionally  a  judicious  and  necessary  measure,  when  the 
patient  does  not  proceed  prosperously. 

The  slightest  alarm  is  still  more  serious  in  its  effects.  No  disease,  generally 
speaking,  is  so  formidable  as  that  which  is  induced  by  fright.  All  sudden 
noises;  all  rapid  movements  in  nursing,  &c.,  should  be  carefully  avoided.     The 

39* 


462  Progress  of  the  Medical  Sciences.  [Oct. 

infant  should  be  addressed  in  a  soft  and  soothing  tone  of  voice.     In  a  word, 
every  source  of  mental  emotion  should  be  most  carefully  avoided. 

II.  In  reference  to  the  morbid  susceptibility  of  the  little  patient,  it  is,  1  believe, 
best  subdued  by  the  tincture  of  hyoscyamus  and  the  infusion  of  the  humulus 
lupulus.  The  system  may  be  kept  constantly  under  the  gentle  influence  of 
these  remedies;  that  of  the  exciting  causes  is  then  less  injurious.  The  gentle 
tonic  influence  of  sponging  the  general  surface  with  tepid  salt  water  is  also 
highly  beneficial.  All  inclemencies  of  the  weather  being  avoided — for  heat, 
cold,  and  the  northeasterly  winds,  are  alike  injurious — the  child  should  be  much 
in  the  open  air.  It  should  be  protected,  not  only  by  the  shade^  but  by  a  flannel 
dress  which  should  cover  every  part  of  the  surface,  whilst  the  clothing  in  gene- 
ral should  be  suited  to  the  season. 

III.  I  must  now  make  a  few  remarks  on  the  pathology  of  this  affection,  and 
especially  on  the  connection  which  the  condition  of  the  thymus  gland  has  been 
supposed  to  have  with  it. 

Much  has  been  said  by  various  authors  about  the  enlarged  condition  of  this 
gland  as  the  cause  of  the  crowing  inspiration  and  convulsion.  They  have  been 
deceived  by  the  morbid  appearances.  They  have  not  reflected  that  enlargement 
of  the  thymus  might  be  a  natural  effect  of  the  violent  convulsive  eflforts  observed 
in  this  terrific  malady.  I  have  known  the  thyroid  gland  become  and  remain 
enlarged  in  like  manner  after  the  efforts  of  severe  and  protracted  labour.  I  have 
known  the  eyes  to  be  bloodshot  from  hooping-cough;  the  eyelids  to  be  ecchy- 
mosed,  in  spots,  from  epilepsy,  and  from  the  efforts  of  vomiting  and  parturition. 

In  this  manner  we  may  understand  how  enlargement  of  the  thymus  may  be 
an  effect  of  this  formidable  disease.  Viewed  in  this  point  of  light,  we  can 
readily  imagine  that  it  would  subside  with  the  disease.  In  this  manner  we  are 
led  to  consider  the  disease  as  not  necessarily  incurable,  which  it  must  be  if  it 
depended  on  organic  change  of  structure.  This  case  affords  another  example,  of 
morbid  anatomy,  erroneously  interpreted,  leading  to  erroneous  views  of  disease. 

If  we  carry  our  views  to  the  condition  of  the  brain,  and  bear  in  mind  the 
effect  of  the  convulsive  eflTort  on  the  thymus  gland,  and  on  the  face,  we  shall 
see  the  great  importance  of  adopting  measures  which  may  relieve  the  congested 
encephalon.  Unfortunately,  depletion  adds  to  the  susceptibility  of  the  nervous 
system,  and  therefore  to  the  disposition  to  attacks.  The  spirit-lotion  applied  to 
the  head  seems  to  be  the  safest  remedy,  as  well  as  the  most  efficacious  one.  In 
severe  cases  the  ice-cap  should  be  applied. 

As  a  confirmation  of  these  views,  I  may  mention  that  it  has  never  been  my 
lot  to  see  the  veins  on  the  forehead  of  a  little  patient  so  enlarged,  as  the  case  in 
question. 

In  conclusion,  I  may  repeat  that  no  case  could  present  a  more  marked  diathesis 
of  the  convulsive  character  than  this  little  patient.  One  of  nine  children,  all  of 
whom  had  suffered  from  the  crowing  convulsion,  three  having  died,  and  one 
having  presented  the  appearance  of  enlarged  thymus,  the  principle  of  the  total 
removal  of  all  irritation,  gastric,  intestinal,  and  dental,  succeeded,  nevertheless, 
in  subduing  the  disease.  The  stomach  and  bowels  having  been  cleared,  we  pro- 
cured a  healthy  nurse,  letting  her  milk  be  the  only  food;  we  kept  the  bowels 
free  by  the  mildest  measures  (for  I  am  convinced  that  rough  ones,  and  especially 
calomel  and  senna,  frequently  induce  the  attack;)  and  we  kept  the  gums  free 
from  irritation  by  the  use  of  the  gum-lancet;  and  under  this  treatment  the 
child  has  done  well.  A  cold  spirit-lotion  applied  to  the  crown  of  the  head,  and 
change  of  air,  and  especially  the  sea-breezes,  doubtless  also  contributed  their 
aid  in  the  cure.  I  have  frequently  had  to  remark  the  baneful  influence  of  the 
northeast  wind,  and  the  beneficial  influence  of  change  of  air  on  this  disease,  as 
in  pertussis,  with  which  it  seems,  indeed,  to  possess  various  points  of  resem- 
blance, not  to  say  connection. — Lancet,  July  9,  1842. 

27.  Two  fatal  cases  of  Laryngismus  Stridulus. — Mr.  F.  Ryland  of  Birmingham, 
relates  in  the  Prov.  Med.  ^  Surg.  Journ.  July  30,  1842,  two  fatal  cases  of  laryn- 
gismus stridulus,  with  the  appearances  after  death. 


1842.]  Medical  Pathology  and  Therapeutics.  463- 

The  first  case  occurred  in  a  boy,  who  had  been  habitually  costive,  and  who 
when  six  months  of  age,  became  unhealthy  in  appearance;  his  skin  soft;  restless 
at  night;  occasionally  had  severe  fits  of  crying;  and  his  thumbs  were  constantly 
drawn  towards  the  palms  of  his  hands.  Two  weeks  afterwards  he  was  ob- 
served occasionally  to  make  a  croupy  noise  in  breathing,  and  some  days  subse- 
quently, he  had  two  or  three  severe  fits  of  laryngismus.  These  fits  occurred 
occasionally  during  a  month,  and  in  one  of  them  he  suddenly  expired. 

"An  examination  was  made  of  the  body  forty-five  hours  after  death.  The 
veins  about  the  head  and  neck  were  distended  by  dark  fluid  blood.  There  was 
a  considerable  deposition  of  serum  within  the  membranes  external  to  the  brain, 
and  the  convolutions  were  much  separated  from  each  other  by  this  effusion.  No 
milkiness  of  the  arachnoid;  the  veins  of  the  meninges  were  distended  with 
blood.  The  brain  itself  was  quite  healthy,  and  the  ventricles  contained  rather 
more  fluid  than  ordinary,  but  not  much.  In  the  membrane  at  the  base  of  the 
brain,  Dr.  Evans,  who  did  me  the  favour  to  assist  me  in  the  examination,  dis- 
covered four  or  five  semi-transparent  bodies  of  the  size  of  millet  seeds,  which  he 
thought  were  tubercles.  On  opening  the  chest  the  thymus  appeared  large,  it 
was  not  measured,  but  its  weight  was  nine  drachms  and  a  half.  It  was  in  con- 
tact posteriorly  with  the  innominata  vein,  the  trachea,  and  the  pericardium.  It 
was  of  a  pinkish  colour,  and  contained  much  milky  fluid.  Neither  before  death 
nor  afterwards  could  we  detect  any  enlarged  glands  in  the  neck.  The  nervus 
vagus  and  the  recurrent  appeared  to  be  quite  normal." 

The  second  case  was  a  brother  to  the  preceding,  and  until  fourteen  months  of  age 
had  no  spasm  of  the  glottis  or  indeed  any  disease,  except  a  severe  diarrhoea  when 
a  year  old,  which  reduced  him  much.  When  fifteen  months  old,  he  began  to 
experience  occasional  fits  of  laryngismus;  which  continued  to  recur  at  infervals 
for  two  months,  when  in  one  of  them  he  expired. 

Fost-mortem  Examination  thirty-two  hours  after  Death. — The  thymus  was 
normal  as  to  size  and  appearance;  certainly  it  was  not  large  in  any  direction. 
The  lungs  were  emphysematous  over  the  greater  part  of  their  external  surface; 
internally  they  were  healthy  and  only  slightly  congested.  There  was  no  fluid 
in  the  pleurae.  The  veins  about  the  neck  were  distended  with  dark  fluid  blood. 
The  larynx,  trachea,  and  larger  bronchi  were  of  a  pale  red  colour,  from  increased 
vascularity,  the  mucous  membrane  of  the  larynx  was  thickened  as  well  as 
vascular.  The  rima  was  quite  closed,  this  closure  being  the  effect  of  muscular 
action,  as  it  was  readily  opened  by  a  probe,  and  remained  open  afterwards.  The 
trachea  and  bronchi  contained  a  large  quantity  of  mucus.  The  glands  about  the 
arch  of  the  aorta  were  enlarged  and  vascular;  there  were  no  glands  about  the 
subclavian  artery  where  it  is  encircled  by  the  right  recurrent  nerve.  The  recur- 
rents  were  of  a  natural  size  and  appearance,  and  were  not  attached  to,  nor 
pressed  upon  by  any  absorbent  glands  in  any  part  of  their  course. 

The  head  was  next  examined.  The  veins  and  sinuses  of  the  membranes  of 
the  brain  were  distended  with  blood  to  an  extent  such  as  I  never  saw  surpassed, 
and  within  the  substance  of  the  brain  the  same  distension  of  the  vessels  existed. 
There  was  no  fluid  either  beneath  the  membranes  or  within  the  ventricles,  ex- 
cept at  the  base  of  the  brain,  where  the  quantity  of  fluid  was  perhaps  more  than 
natural;  no  milkiness  of  the  arachnoid.  The  brain,  cerebellum,  and  medulla 
oblongata  were  perfectly  normal.  No  diseased  appearance,  in  fact,  existed 
within  the  cranium  except  the  extreme  turgidity  of  the  vessels,  which  was  un- 
doubtedly owing  to  the  last  struggle. 

Remarks. — The  proximate  cause  of  death  in  both  cases  was  the  same — viz., 
suflfocation  from  spasmodic  closure  of  the  rima  glottidis  and  tetanic  rigidity  of 
the  muscles  concerned  in  carrying  on  the  respiratory  process.  The  exciting 
cause  of  the  spasmodic  action  of  the  muscles  of  the  larynx  appears  to  have  been 
in  Case  I.,  dentition  complicated  with  head  affection;  the  determination  of  the 
diseased  action  to  certain  muscles  being  attributable,  I  presume,  to  constitutional 
predisposition.  The  source  of  the  disease  was  in  the  nervous  centres;  the 
exciting  causes  of  the  paroxysms,  where  any  could  be  made  out,  were,  besides 
dental  irritation,  thwarting,  vexation,  or  mental  disturbance.     The  excito-moiori/ 


464  Progress  of  the  Medical  Sciences,  [Oct. 

theory  which  has  been  so  strongly  insisted  upon  by  Dr.  Marshall  Hall  as  expla- 
natory of  the  phenomena  of  this  disease,  offers  a  reason  for  the  peculiar  excita- 
bility of  the  muscles  of  the  larynx  in  the  irritation  of  the  dental  branches  of  the  fifth 
pair  of  nerves;  it  thus  shows  the  course  of  the  diseased  action,  but  leaves  us  still 
in  the  dark  as  to  the  cause  why  a  peculiar  spasmodic  action  of  the  laryngeal 
muscles  should  take  place  in  certain  cases  of  dental  irritation,  whilst  in  other  cases 
general  convulsions,  carpo-pedal  contractions,  or  other  well-known  effects  should 
arise  from  apparently  similar  circumstances. 

The  exciting  cause  of  the  spasmodic  action  of  the  muscles  of  the  glottis  in 
Case  II.  appears  to  have  been  inflammation  of  the  larynx  and  bronchial  tubes, 
together  with  dental  irritation.  The  usual  signs  of  head  affection  were  absent 
both  before  and  after  death;  the  thymus  were  perfectly  normal  in  appearance; 
the  recurrent  nerve  was  unimpeded  in  its  action;  the  stomach  and  bowels  were 
free  from  disease,  and  performed  their  functions  properly.  No  other  commonly 
accepted  cause  of  the  laryngeal  spasm  remains  but  bronchitis  and  dental  irrita- 
tion combined  with  hereditary  predisposition.  Lancing  the  gums  was  ser- 
viceable only  in  the  early  stages  of  the  complaint,  therefore  I  am  disposed  to 
exclude  dental  irritation  from  the  list  of  causes  in  the  latter  periods  of  the  pa- 
tient's life,  and  to  ascribe  the  continuance  of  the  disease  to  the  catarrhal  affection 
only.  I  need  scarcely  add,  that  Dr.  M.  Hall's  theory,  whilst  it  explains  in  the 
latter  case  as  in  the  former  the  course  of  the  disease,  fails  in  pointing  out  its 
cause. 

28.  Statistics  of  Phthisis. — Dr.  Hughes  has  collected  a  series  of  cases  of 
phthisis  observed  by  himself,  from  which  he  obtains  the  following  statistics: — 
The  number  of  cases  is  250,  of  which  175  were  males  and  75  females;  of  these 
there  were  203,  of  which  138  were  men  and  65  women,  whose  chests  were  only 
explored  during  life.  The  remaining  48,  of  which  37  were  men  and  11  wo- 
men, were  examined  after  death.  Of  these,  the  left  side  was  chiefly  diseased 
in  116  cases,  or  46  per  cent.;  the  right  in  89,  or  36  per  cent.;  the  more  diseased 
side  was  doubtful  in  45  cases,  or  18  per  cent.  Of  the  116  cases  on  the  left  side, 
there  were  76  males,  43  per  cent.,  40  females,  53  per  cent.;  of  the  89  cases  on 
the  right  side,  there  were  66  males,  38  per  cent.,  23  females,  30  per  cent.;  of 
the  45  cases  in  which  the  more  diseased  side  was  doubtful  there  were  33  males, 
19  per  cent.,  12  females,  16  per  cent.  Of  the  48  cases  examined  after  death,  of 
which  11  only  were  females,  and  37  males,  the  tubercles  were  confined  to  the 
left  lung  in  3  males  and  1  female,  and  to  the  right  lung  in  1  male  only.  From 
this  it  appears  that  there  is  a  somewhat  greater  liability  to  tubercular  action  on 
the  left  side  of  the  chest  than  on  the  right. 

Of  these  250  cases,  the  upper  lobe  of  one  or  both  lungs  was  solely  or  princi- 
pally diseased  in  237,  or  95  per  cent.  Of  the  12  remaining  cases,  of  which  II 
occurred  in  males  and  only  2  in  females,  there  were  9,  or  3  and  3-5ths  per  cent, 
of  the  whole  number,  in  which  both  lungs  were  universally  and  uniformly  dis- 
eased; of  these,  8  were  males  and  I  was  a  female;  of  the  remaining  4  cases, 
the  upper  lobe  in  3  was  at  least  equally  affected  with  other  parts,  and  in  the 
fourth  the  tubercles  were  deposited  in  the  base,  and  were  not  found  in  the  upper 
part  of  the  lung.  This  last  case  was  that  of  a  poor  boy,  who  had  large 
opaque  tubercles  in  the  peritoneum,  diseased  mesenteric  glands,  faecal  abscess 
from  ulceration  of  the  intestine,  chronic  bronchitis,  a  few  tubercles  in  the  right 
lung,  suppurating  bronchial  glands,  and  at  the  base  of  the  left  lung  largely  di- 
lated bronchial  tubes  filled  with  purulent  mucus,  and  chronic  pneumonia.  There 
were  also  in  the  same  part  a  few  transparent  tubercles,  and  in  one  portion,  about 
as  large  as  a  walnut  and  not  consolidated  by  pneumonia,  there  were  several  of 
these  bodies,  which  were  larger  and  perfectly  opaque.  Tubercles  are  deposited 
first  in  the  upper  part  of  the  lung  in  the  proportion  of  94  per  cent. 

After  puberty,  phthisis  is  most  generally  fatal  between  the  ages  of  20  and  30; 
next,  between  20  and  40;  then  between  40  and  50;  below  20  and  above  50  the 
mortality  from  this  disease  is  very  much  diminished.  Fewer  females  than  males 
affected  with  this  disease  attain  the  age  of  40;  in  other  words,  women  die  of 


1842.]  Surgery,  465 

consumption  at  rather  an  earlier  ao-e  than  men.  Dr.  Hughes  states  further,  that 
tubercles  may  be  simultaneously  deposited  throughout  both  lungs,  and  may  then 
present  no  other  physical  signs  than  those  of  bronchitis,  but  this  form,  which  is 
comparatively  very  rare,  is  not  necessarily  acute,  and  confined  to  young  persons. 
— Prov.  Med.  and  Surg.  Journ.  June  4,  1842,  from  Guyh  Hospital  Repcn-ts. 

29.  Statistical  Researches  into  the  Etiology  of  Pulmonary  Phthisis. — M.  Briquet 
has  published  in  the  Revue  Medicale,  Feb.  1842,  a  paper  founded  on  an  investi- 
gation into  various  particulars  connected  with  the  history  of  109  phthisical 
patients  in  whom  the  disease  was  far  advanced,  and  likewise  on  data  furnished 
by  all  the  deaths  from  phthisis  in  the  hospital  between  January  1st,  1838,  and 
January  1st,  1841,  being  182  in  number. 

The  conclusions  at  which  M.  Briquet  arrives,  are: 

1.  That  during  the  past  three  years  one  tenth  more  of  men  than  of  women 
have  been  received  into  the  Hopital  Cochin  affected  with  phthisis:  a  result 
directly  contrary  to  those  obtained  by  MM.  Lombard  and  Louis. 

2.  In  at  least  a  third  of  the  patients  phthisis  was  distinctly  hereditary,  and 
predisposition  to  the  disease  seemed  more  frequently  to  come  from  the  father 
than  the  mother. 

3.  No  immunity  from  the  disease  is  afforded  by  the  circumstance  of  being 
born  of  parents  who  are  natives  of  the  country,  or  by  being  brought  up  in  the 
country. 

4.  Tall  stature,  a  slender  frame,  an  ill  formed  chest,  and  convexity  from  the 
root  to  the  point  of  the  nails  are  the  only  external  characteristics  of  phthisical 
diathesis. 

5.  It  occurred  very  seldom  that  the  circumference  of  the  upper  part  of  the 
chest  was  less  than  that  of  the  lower  part:  a  fact  directly  contrary  to  the  asser- 
tion of  M.  Hertz. 

6.  Those  callings  in  the  pursuit  of  which  there  is  discomfort,  want  of  exer- 
cise and  of  pure  air  present  a  greater  number  of  phthisical  persons  than  is  to 
be  found  among  those  who  pursue  different  occupations. 

7.  A  third  of  these  patients  were  more  subject  to  catarrh  than  other  persons, 
and  were  more  sensible  of  cold. 

8.  In  three-fifths  of  the  patients  phthisis  developed  itself  between  twenty  and 
thirty  years  of  age,  but  more  than  two-thirds  of  those  whose  parents  had  suffered 
from  consumption  became  phthisical  before  their  thirtieth  year;  while,  of  those 
whose  parents  had  not  been  healthy,  half  did  not  show  symptoms  of  phthisis 
till  after  thirty. 

9.  In  four-fifths  of  the  patients  there  existed  predisposition  to  phthisis,  and  in 
three-fifths  this  predisposition  was  acquired. 

10.  Cold  is  the  most  powerful  cause  of  the  acquired  predisposition:  next  to 
which  are  misery,  privation,  and  distress  of  mind. 

11.  Phthisis  is  most  frequent  in  cold  seasons,  and  when  there  are  many  vari- 
ations in  the  atmosphere. 

12.  Four-tenths  of  the  patients  had  not  been  exposed  to  the  influence  of  any 
occasional  cause  of  phthisis,  but  in  most  there  existed  a  strong  predisposition  to 
the  disease. 

Five  tenths  had  been  exposed  to  and  suffered  greatly  from  some  exciting 
cause,  and  this  cause  was  in  almost  every  instance  cold  and  damp.— Brit,  and 
For.  Med.  Rev.  July,  1842. 


SURGICAL  PATHOLOGY  AND  THERAPEUTICS,  AND  OPERA- 
TIVE SURGERY. 

30.  Ecchymosis  from  injury  simulating  laceration  of  an  artery  of  the  part. — Dr. 
Houston  communicated  to  the  Surgical  Society  of  Ireland,  (May  14,)  two  inte- 
resting cases  of  accident,  in  which  simple  ecchymosis  assumed  so  strikingly  the 


466  Progress  of  the  Medical  Sciences.  [Oct 

symptoms  of  laceration  of  the  principal  artery  of  the  part,  as  to  render  the  diag- 
nosis extremely  difficult. 

Jpril  1,  1842.— James  Barrett,  a  strong-,  healthy  labouring  man,  was  admit- 
ted into  the  City  of  Dublin  Hospital.  About  two  hours  before  admission,  he 
had  been  struck  and  knocked  down  by  an  iron  beam  falling  on  his  back  and 
hams,  and  which  was  so  heavy  that  he  could  not  move  until  it  was  lifted  off 
him.  He  complained  of  excruciating  pain  in  the  back,  and  inability  to  stand,  or 
to  move  the  lower  extremities;  but  these  were  not  paralyzed,  as  they  still  pos- 
sessed sensibility.  He  has  also  voided  urine  since  the  accident.  The  right 
limb  he  describes  as  having  been  twisted  under  him  at  the  knee,  in  the  fall,  so 
much  that  his  comrades  pulled  it  to  set  it  straight.  There  was  a  palpable  rup- 
ture of  the  internal  lateral  ligament  of  the  knee-joint.  The  tibia  could  be  pushed 
outwards,  so  as  to  separate  the  condyles  of  the  tibia  and  femur  from  each  other 
to  some  distance,  and  in  being  replaced  suddenly,  to  produce  an  audible  sound. 
The  pain  attending  this  motion  was  not  great;  neither  was  there  much  effusion 
into  the  cavity  of  the  joint. 

But  the  left  limb  is  that  respecting  which  this  communication  is  here  offered. 
In  the  left  ham  there  was  a  swelling  better  than  a  foot  in  length,  tense  and  fluc- 
tuating, without  particular  pain  on  pressure — evidently,  a  great  and  recent  extra- 
vasation of  blood.  Tt  was  soft,  opposite  the  popliteal  space,  and  firm  and  resist- 
ing above  and  below.  There  was  no  pulsation  in  it.  The  pulse  in  the  anterior 
and  posterior  tibial  arteries  had  ceased  to  beat.  There  was  complete  loss  of 
sensation  in  the  outer  part  of  the  leg  and  foot,  corresponding  to  the  distribution 
of  the  branches  of  the  perineal  nerve;  and  the  foot  was  cold  and  slightly  (Edema- 
tous. The  symptoms  were,  in  short,  so  analogous  to  those  likely  to  attend  on 
a  sudden  rupture  of  popliteal  artery  and  perineal  nerve,  that  not  one  of  the  expe- 
rienced gentlemen  who  saw  the  patient,  would  venture  to  say  that  such  was  not 
the  nature  of  the  lesion.  The  formation  of  such  a  tumour  in  less  than  two  hours, 
from  a  blow  capable  of  producing  so  much  injury  to  the  back  and  opposite  limb 
— the  stoppage  of  the  pulse  in  the  main  vessels  of  the  foot,  and  the  loss  of  sen- 
sation, together  with  the  coldness  and  oedema  of  that  part,  were  all  character- 
istic symptoms  of  such  an  injury. 

As  the  man  was  faint  and  frightened,  some  warm  wine  and  an  anodyne  were 
given,  and  cold  lotions  applied  to  the  tumour.  Under  this  treatment,  time  was 
given  for  the  nature  of  the  accident  more  fully  to  develope  itself. 

In  six  hours,  the  patient  had  rallied  from  his  faintness,  but  there  was  no  in- 
crease in  the  amount  of  extravasation.  In  twelve  hours,  the  parts  had  remained 
in  statu  quo:  the  tumour  was  there,  but  had  not  increased:  the  foot  was  still 
pulseless  and  cold;  but  these  conditionsliad  not  undergone  any  change  or  aggra- 
vation. It  became  now  pretty  certain,  that  whatever  might  have  been  the  source 
of  the  extravasated  blood,  the  main  artery  of  the  limb  still  remained  unbroken, 
as  with  such  a  lesion  as  that,  the  symptoms  must  have,  in  some  degree  at  least, 
made  progress.  On  this  head,  therefore,  our  apprehensions  were  for  the  time, 
much  relieved.  In  two  days,  the  tension  of  the  tumour  began  to  lessen;  and  on 
the  fifth  morning,  but  not  sooner,  the  pulse  was  discoverable  again  in  both  the 
anterior  and  posterior  tibial  arteries;  although  the  diminished  power  of  sensation 
remained  the  same  as  before.  On  the  ninth  day,  there  was  considerable  dimina- 
tion  in  the  size  and  resistance  of  the  tumour;  but  there  was  extensive  blacken- 
ing from  ecchymosis  up  and  down  the  back  of  the  limb.  The  pulse  in  the  ves- 
sels of  the  foot  had  regained  its  strength,  and  there  was  some  improvement  in 
the  sensibility  of  the  limb.  It  is  now  six  weeks  since  the  accident,  and  the 
report  is,  that  the  tumour  is  nearly  gone;  that  the  circulation  in  the  limb  is  per- 
fect; but  that  the  sensibility,  although  much  improved,  is  not  fully  re-estab- 
lished. Considerable  soreness  in  the  ham,  particularly  along  the  inner  side,  the 
effects  of  the  blow,  remain. 

Respecting  the  opposite  knee — the  subject  of  the  laceration  of  the  internal 
lateral  ligament — I  may  state,  that  it  was  put  up  in  splints  in  the  straight 
posture,  soon  after  the  accident,  and  kept  so  for  three  weeks,  when  on  examina- 
tion, it  was  found  so  far  improved,  that  while  permitting  the  ordinary  motions 


1842.]  Surgery,  467 

of  flexion  and  extension,  it  was  so  strong  as  not  to  yield  to  a  moderate  force, 
calculated  to  bend  the  tibia  outwards,  and  that  it  is  now  strong  enough  to  give 
firm  support  to  the  limb,  in  standing.  i 

As  to  the  source  of  the  blood  poured  ont  so  rapidly  and  in  such  quantity,  Mr. 
Houston  observed  that  the  fluid  came  most  probably  from  some  large  vein,  and 
was  checked  in  its  flow  as  soon  as  the  tumour  reached  a  size  sufficient  to  make 
pressure  on  the  open  mouth  of  the  vein  which  furnished  it.  The  pulseless  state 
of  arteries  of  the  foot  and  leg,  the  circumstance  most  worthy  of  notice  in  the 
case,  may  have  arisen  from  the  pressure  of  the  extravasated  blood  on  the  trunk 
of  the  popliteal  artery;  and  the  loss  of  sensibility  complained  of  in  the  outer 
part  of  the  foot  and  leg,  we  may  suppose  to  have  been  the  result  of  a  stretching 
of  the  perineal  nerve,  rather  than  of  a  rupture  of  that  cord,  as,  had  the  latter 
been  the  nature  of  the  lesion,  a  restoration  of  the  nervous  function  would  not 
have  been  so  soon  accomplished. 

The  second  case  of  which  Dr.  Houston  spoke  was  communicated  to  him  by 
Dr.  Martin,  of  Portlaw,  and  which,  from  its  resemblance  to  the  foregoing  in 
several  essential  particulars,  deserves  to  be  recorded  with  it,  although  the  region 
of  the  body  engaged  was  ditferent.  A  young  woman,  in  a  playful  struggle  with 
a  fellow-servant,  suddenly  heard  something  snap,  as  it  were,  in  her  neck,  and  in 
a  very  short  time  observed  a  tumour  in  the  lower  part  of  the  neck.  The  tumour 
increased,  and  on  the  third  day,  when  Dr.  Martin  saw  it,  had  attained  a  size  of 
about  half  an  orange.  It  lay  an  inch  and  a  half  above  the  right  sterno-clavicular 
articulation,  partly  overlapped  by  the  anterior  edge  of  the  sternd-mastoid  mus- 
cle. The  tumour  pulsated  violently,  was  painful,  and  interfered  very  much  with 
deglutition.  The  pulsation  in  the  branches  of  the  carotid  of  that  side,  although 
not  stopped  altogether,  was  much  weaker  than  that  in  the  corresponding  branches 
of  the  side  opposite. 

Notwithstanding  the  many  points  of  resemblance  which  the  case  bore  to  one 
of  carotid  aneurism.  Dr.  Martin,  from  observing  an  absence  of  any  bruit  under 
the  stethoscope,  and  noticing  that  the  tumour,  while  appearing  to  pulsate,  under- 
went no  lateral  dilatation  or  enlargement  with  the  strokes  of  the  pulse,  diag- 
nosed the  case  to  be  one  of  circumscribed  ecchymosis  consequent  upon  the  rup- 
ture of  some  small  vessel. 

In  five  or  six  weeks  the  tumour  disappeared,  leaving  no  injurious  effects 
behind. — Dublin  Med.  Press,  June  15,  1842. 

31.  Rupture  of  the  Urethra,  with  extravasation  of  urine  into  the  scrotum  and 
penis. — Dr.  Bellingham  communicated  the  following  example  of  this  to  the 
Surgical  Society  of  Ireland. 

M.  L.,  astat.  54,  a  servant,  was  admitted  into  St.  Vincent's  Hospital  on  the 
evening  of  5th  March,  1842.  He  stated  that  within  the  last  twelve  months  he 
had  been  obliged  to  pass  water  more  frequently  than  before;  it  came  away  in  a 
smaller  stream  than  usual,  and  in  small  quantity  at  a  time;  within  the  last  three 
months  these  symptoms  have  increased;  he  never,  however,  applied  for  advice, 
as  it  did  not  prevent  his  attending  to  his  business;  neither  does  he  know  to  what 
to  attribute  it.     He  says  his  habits  are  regular,  and  that  he  does  not  drink. 

Three  days  previous  to  his  admission,  towards  evening,  he  was  suddenly  seized 
with  a  fit  of  shivering  when  employed  about  his  business;  it  increased,  he  says, 
at  night,  and  the  urine  came  away  in  a  smaller  stream.  The  next  night  he  had 
a  very  severe  and  long-continued  fit  of  shivering,  and  could  pass  but  very  little 
urine.  He  took  a  dose  of  castor  oil  at  this  time,  and  passed  some  urine  with  a 
purgative  stool. 

When  admitted  into  the  hospital  the  shiverings  had  ceased;  he  was  able  to 
pass  urine  in  a  small  stream;  there  was  pain  over  the  pubes,  and  the  distended 
bladder  could  be  felt  above  it;  the  scrotum  appeared  to  be  slightly  swollen,  and 
there  was  a  little  fulness  in  the  perineum.  The  pulse  was  quick  and  weak;  the 
skin  hot  and  dry,  thirst  and  furred  tongue. 

An  attempt  was  made  to  pass  a  gum  elastic  catheter  of  small  size  into  the 
bladder,  but  without  success.     He  was  then  placed  in  a  hip-bath,  and  leeches 


468  Progress  of  the  Medical  Sciences.  [Oct. 

and  fomentations  were  applied.  He  passed  some  urine  in  the  bath,  and  felt 
somewhat  relieved. 

^  March  1th. — At  the  hour  of  visit,  the  scrotum  and  penis  were  found  to  be 
much  swollen,  and  tense;  the  skin  of  a  red  colour;  there  was  considerable  rest- 
lessness and  uneasiness;  the  tongue  was  covered  with  a  thick  fur,  and  dry;  the 
pulse  weak  and  intermittent.  He  said  that  in  endeavouring  to  pass  urine,  he 
found  that  it  did  not  come  away  as  before. 

There  being  no  doubt  that  rupture  of  the  urethra,  and  extravasation  of  urine 
into  the  subcutaneous  cellular  membrane  of  the  scrotum  and  penis  had  takea 
place,  an  attempt  was  again  made  to  introduce  a  gum  elastic  catheter,  and 
repeated  by  Mr.  Wilmot,  but  with  no  better  success.  The  patient  was  then 
placed  under  the  edge  of  a  table  in  the  position  for  lithotomy,  a  staff  was  passed 
down  to  the  seat  of  the  obstruction,  and  an  incision  made  in  the  perineum  upon 
its  point;  the  urethra  being  now  opened,  an  endeavour  was  made  to  pass  a  small 
catheter,  and  afterwards  a  bent  probe  towards  the  bladder,  but  without  effect; 
the  opposite  extremity  of  the  urethra  could  not  be  found.  Free  incisions  were 
then  made  in  the  scrotum  and  penis,  which  gave  exit  to  urine  and  blood.  He 
was  placed  in  bed,  and  an  emollient  poultice  applied  over  the  parts. 

On  visiting  him  some  hours  afterwards,  I  found  that  he  had  passed  a  good 
deal  of  urine  by  the  opening  in  the  perineum,  and  that  the  incisions  in  the  scro- 
tum and  penis  had  bled  freely;  and  though  weak,  he  felt  himself  considerably 
relieved. 

It  is  unnecessary  to  detail  the  daily  progress  of  the  case.  The  urine  continued 
to  come  partly  by  the  wound  in  the  perineum,  and  partly  by  the  natural  passage; 
suppuration  occurred  about  the  root  of  the  penis,  and  a  good  deal  of  healthy  pus 
was  discharged  from  the  incisions  which  had  been  made  there,  the  others  gra- 
dually healed.  The  swelling  of  the  scrotum  subsided  first,  afterwards  that  of 
the  penis;  his  appetite  and  strength  returned,  and,  March  '21sl,  a  fortnight  after 
the  operation,  he  found  himself  so  well  that  he  was  up  all  day,  and  the  urine 
came  altogether  by  the  penis;  none  by  the  incision  in  the  perineum. 

29/A.  The  incision  in  the  perineum  is  almost  healed;  the  patient  passes  urine 
in  a  full  stream,  and  has  not  the  slightest  uneasiness  of  any  kind.  He  is  goings 
home  to-day  or  to-morrow,  exactly  three  weeks  after  the  rupture  of  the  urethra, 
and  extravasation  of  urine. 

There  are  some  points  of  interest  connected  with  this  case,  upon  which  I  may 
delay  for  a  few  minutes.  One  was  the  complete  absence  of  sloughing  of  the 
cellular  membrane,  although  the  parts  were  probably  infiltrated  with  urine  for 
several  hours;  this,  I  believe,  very  rarely  happens,  as  when  the  urine  has  been 
retained  for  any  length  of  time  in  the  bladder,  its  irritating  properties  become 
proportionably  increased,  and  the  tissues  into  which  it  extends  in  such  cases 
rarely  escape  gangrene.  Indeed,  all  writers  upon  the  subject  agree  upon  this 
point.  Desault  says,  the  urine  of  all  the  fluids  in  the  economy,  is  that  the 
extravasation  of  which  is  the  most  destructive;  if  not  very  promptly  evacuated, 
it  kills  the  parts  into  which  it  extends,  and  causes  gangrenous  inflammation  of 
the  skin. 

Boyer  repeats  verbatim  what  I  have  quoted  from  Desault. 

Cooper,  in  his  Surgical  Dictionary,  says  when  the  extravasation  is  extensive, 
the  incisions  should  be  multiplied.  It  would  be  absurd  to  spare  the  parts,  for 
all  those  with  which  the  urine  has  come  in  contact,  seldom  escape  mortification; 
the  incisions  which  are  made,  hardly  ever  have  the  effect  of  saving  them;  but  by 
accelerating  the  discharge  of  putrid  sanies  and  stagnant  urine,  they  prevent  mis- 
chief which  would  originate  from  a  further  lodgment.  This  is  simply  a  trans- 
lation of  what  Desault  has  said  in  another  place.  And  Sir  B.  Brodie,  in  his 
lectures  on  the  diseases  of  the  urinary  organs,  says,  wherever  the  urine  pene- 
trates, it  first  inflames,  and  then  kills  the  part. 

Another  point  connected  with  the  case  worthy  of  observation,  was  the  perfect 
cure  of  the  stricture  which  followed  the  rupture  of  the  urethra;  the  patient  Ijfeing 
able  before  he  left  the  hospital,  to  pass  urine  in  a  full  stream;  which  he  had  not 
done  for  a  considerable  time  before. 


1842.]  Surgery. 

Lastly,  and  a  point  of  practical  value  in  this  case  is,  that  it  illustrates  remark- 
ably the  importance  of  making-  a  free  incision  in  the  perineum  as  soon  as  possi- 
ble after  the  accident,  so  as  to  allow  a  free  exit  for  the  urine:  there  can  be  little 
doubt,  that  if  this  treatment  had  not  been  adopted  in  the  present  instance,  the 
patient  would  have  sunk,  as  he  was  very  low  at  the  period  of  the  operation;  he 
was  advanced  in  years;  and  in  addition,  he  was  labouring  under  chronic  bron- 
chitis at  the  time. — Ibid. 

32.  Spontaneous  Fracture  of  the  Thigh-bone. — Mr.  Toogood  of  Bridg-water, 
relates  in  the  Prov.  Med,  Joicrn.-,  (9th  July,  1842,)  two  cases  of  fracture  of  the 
thigh,  witiiout  any  external  violence,  which  have  occurred  in  his  practice.  The 
first  was  that  of  a  man  who  had  for  many  years  been  in  a  weak,  nervous,  and 
half  paralytic  state.  In  attempting  to  turn  in  bed,  the  bone  broke.  The  case 
was  considered  an  extraordinary  one;  it  was  treated  in  the  usual  way,  and  united 
after  a  considerable  time,  and  he  lived  many  years  after.  The  next  case  was 
that  of  James  Pople's  wife,  of  Bawdrip,  aged  fifty-five,  who  had  been  loner  in 
an  infirm  state  of  health,  which  terminated  ultimately  in  paralysis  of  the  lower 
extremities.  She  had  suffered  very  severe  pain  in  her  right  thig'h  for  some 
months,  which  was  considered  by  ihose  about  her  to  be  rheumatic;  and  being  a 
poor  woman  without  friends,  little  was  done  for  her  relief.  One  evening,  on 
being  lifted  up  in  the  bed,  the  bone  suddenly  snapped;  she  was  aware  of  it 
immediately,  and  cried  out  that  her  thigh  was  broken,  but  no  one  believed  her, 
and  she  lay  all  that  night  in  dreadful  agony;  but  when,  on  the  following  morn- 
ing, her  neighbours  saw  the  limb  almost  doubled  by  the  violent  spasmodic  action 
of  the  muscles  which  drew  the  ends  of  the  bones  forcibly  against  each  other,  I 
was  requested  to  see  her.  Her  condition  was  indeed  truly  deplorable,  and  the 
grating  of  the  bones  against  each  other  was  distinctly  heard. 

The  limb  was  placed  in  splints,  and  united  after  a  longer  period  than  usual. 
I  mentioned  this  case  to  Sir  Astley  Cooper,  who  considered  it  to  be  cancer  of 
the  bone,  and  directed  my  attention  to  the  state  of  the  breasts,  in  both  of  which 
I  discovered  on  examination  several  hard,  knotty  tumours,  of  a  carcinomatous 
character. 

The  following  interesting  account  of  a  similar  accident  will  be  found  in  the 
life  of  Archbishop  Seeker:  — 

"  About  a  year  and  a  half  before  he  died,  after  a  fit  of  the  gout,  he  was  at- 
tacked with  a  pain  in  the  arm,  near  the  shoulder,  which,  having  continued  about 
a  twelvemonth,  a  similar  pain  seized  the  upper  and  outer  part  of  the  opposite 
thigh,  and  the  arm  soon  became  easier.  This  was  much  more  grievous  than  the 
former,  as  it  quickly  disabled  him  from  walking,  and  kept  him  in  almost  con- 
tinual torment  except  when  he  was  in  a  reclined  position.  During  this  time 
he  had  two  or  three  fits  of  the  gout,  but  neither  the  gout  nor  medicines  allevi- 
ated these  pains,  which,  with  the  want  of  exercise,  brought  him  into  a  general 
bad  habit  of  body. 

"  On  Saturdajs  the  30th  of  July,  1768,  he  was  seized,  as  he  sat  at  dinner,  with 
a  sickness  at  his  stomach.  He  recovered  himself  before  night,  but  the  next 
evening,  whilst  his  physicians  were  attending,  and  his  servants  raising  him  on 
his  couch,  he  suddenly  cried  out  that  his  thigh-bone  was  broken.  The  shock 
was  so  violent  that  the  servants  perceived  the  couch  to  shake  under  him,  and  the 
pain  so  acute  and  unexpected,  that  it  overcame  the  firmness  he  so  remarkably 
possessed.  He  lay  for  sonie  time  in  great  agonies,  but  when  the  surgeons  arrived, 
and  discovered  with  certainty  that  the  bone  was  broken,  he  was  perfectly  re- 
signed, and  never  afterwards  asked  a  question  about  the  event.  A  fever  soon 
ensued;  on  Tuesday  he  became  lethargic,  and  continued  so  till  about  five 
o'clock  on  Wednesday  afternoon,  when  he  expired  Yi-ith  great  calmness,  in  the 
75th  year  of  his  age. 

"On  examination,  the  thigh-bone  was  found  to  be  carious  about  four  inches  in 
length,  and  at  nearly  the  same  distance  from  its  head.  The  disease  took  its  rise 
from  the  internal  part  of  the  bone,  and  had  so  entirely  destroyed  its  substance, 
that  nothing  remained  at  the  part  where  it  was  broken  but  a  portion  of  its  out- 
No.  VIII.— October,  1842.  40 


470  Progress  of  the  Medical  Sciences,  [Oct. 

ward  integument;  and  even  this  had  many  perforations,  one  of  which  was  lar^e 
enough  to  admit  two  fingers,  and  was  filled  up  with  a  fungous  substance,  aris- 
ing from  within  the  bone.  There  was  no  appearance  of  matter  about  the  caries, 
and  the  surrounding  parts  were  in  a  sound  state.  It  was  apparent  that  the 
torture  which  his  grace  underwent  during  the  gradual  corrosion  of  this  bone, 
must  have  been  inexpressibly  great.  Out  of  tenderness  to  his  family  he  seldom, 
made  any  complaint  to  them,  but  to  his  physicians  he  frequently  declared  his 
pains  were  so  excruciating,  that  unless  some  relief  could  he  procured  he  thought 
it  would  be  impossible  for  human  nature  to  support  them  long;  yet  he  bore  them 
for  upwards  of  six  months  with  astonishing  patience  and  fortitude,  sat  up  gene- 
rally the  greater  part  of  the  day,  admitted  his  particular  friends  to  see  him, 
mixed  with  his  family  at  the  usual  hours,  sometimes  with  his  usual  cheerful- 
ness, and  except  some  very  slight  defects  of  memory,  retained  all  his  faculties 
and  senses  in  their  full  vigour  till  within  a  few  days  of  his  death." 

In  the  second  part  of  the  15ih  vol.  of  the  Medico-Chirurgical  Transactions, 
two  cases  of  fracture  of  the  thigh-bone  taking  place,  without  any  violence,  in 
connection  with  cancer,  are  related  by  Mr.  Salter,  of  Poole,  in  one  of  which  an 
examination  was  afforded  after  death,  and  his  description  of  the  condition  of  the 
bone  corresponds  very  much  with  that  of  the  preceding  case.  No  examination 
could  be  obtained  in  the  case  of  James  Pople's  wife. 

33.  Fracture  of  the  Thigh  ly  muscular  contraction. — M.  Naranovitch  relates,  in 
the  Jniirn.  de  Med.  et  de  PHistoire  NatureUe,  the  following  example  of  this. 

A  cavalry  soldier,  confined  to  hospital  for  a  scrofulous  ulcer  of  the  right  knee, 
was  sitting  on  the  ground,  before  the  fire,  with  his  legs  crossed,  when,  wishing 
to  rise  to  go  to  bed,  without  supporting  himself  on  his  hands,  he  felt  his  right 
thigh  crack,  and  he  immediately  fell  back.  The  femur  was  found  fractured  at 
the  centre.  M.  N.  says,  that  this  case  differs  from  most  of  those  fractures 
caused  by  the  action  of  the  muscles,  in  the  circumstance  that  there  was  no 
pre-existing  disease  in  the  broken  bone.  In  the  position  in  w^hich  the  soldier 
was,  the  femur  represents  a  lever  of  the  third  order,  so  that  the  muscles  gain  in 
rapidity  and  intensity  what  they  lose  in  power  from  the  mode  of  their  insertion. 
It  is  remarkable,  and  this  case  confirms  the  truth  of  the  observation  of  the  author, 
that  the  generality  of  fractures  caused  by  muscular  force  take  place  in  the  thigh. 
Similar  cases  have  been  recorded  by  Samuel  Cooper,  Desportes,  and  Rostan. — 
L.  ^  E.  Month.  Journ.  Med.  Set.,  .luly  1842,  from  Gaz.  Med.  de  Farts,  2d  April, 
1842. 

34.  Dislocation  of  the  lower  Jaw. — Mr.  D.  Donovan  relates,  in  the  Dublin 
Medical  Fress  (May  25,  1842),  a  case  of  dislocation  of  the  lower  jaw  reduced 
by  him  ninety-eight  days  after  the  occurrence  of  the  accident. 

35.  Benzoic  acid  in  Urinary  Disorders. — In  our  No.  for  January  last,  p.  195,  we 
noticed  a  paper  by  Mr.  Ure,  in  which  the  author  extols  the  salutary  effects  of  the 
benzoic  acid  in  correcting  the  urinary  secretion  in  persons  of  a  gouty  habit. 

Dr.  J.  K.  Walker  of  Huddersfield,  in  a  paper  in  the  Frov.  Med.  and  Surg. 
Journ.  Feb.  26,  1842,  confirms  Mr.  Ure's  statements,  and  adds  that  he  has  used 
the  remedy  together  with  the  balsam  copaiba  in  many  cases  of  chronic  dysnria 
occurring  in  old  men,  who  were  subject  to  gout,  with  great  advantage;  and  he 
relates  several  cases  illustrative  of  this  fact,  one  of  which  we  select. 

"  Joseph  L — d,  aged  77,  a  dissenting  minister,  residing  in  this  neighbourhood, 
became  my  patient  some  months  ago,  in  consequence  of  a  very  painful  and  often 
difficult  passage  of  his  water,  an  affection  under  which  he  had  laboured  for  years, 
but  especially  during  the  winter  season.  He  has  been  a  widower  for  many 
years,  and  his  habits  have  been  uniformly  and  strictly  regular  and  temperate. 
He  has  been  remarkably  free  from  illness  of  every  description  previously  to  the 
present  complaint.  There  is  no  perceptible  disease  in  the  prostate  gland,  and 
he  has  never  been  troubled  with  gouty  symptoms.  He  has  undergone  a  variety 
of  treatment  from  his  professional  advisers,  from  which  he  occasionally  derived 


1842.]  Surgery,  471 

partial  and  temporary  relief.  There  appears  to  be  a  glairy  mucous  sediment  in 
the  urine,  in  wiiich,  on  examination,  some  gravelly  particles  may  be  discovered. 
The  pain,  however,  at  this  time  (which  was  early  in  December  last),  especially 
in  voiding  his  urine,  was  very  great,  and  did  not  yield  to  fomentations,  anodynes, 
and  detergent  balsams,  which  were  very  judiciously  resorted  to.  The  benzoic 
acid,  in  doses  of  from  five  to  ten  grains,  vi^as  ordered  along  with  the  balsam  of 
copaiva,  three  or  four  times  a  day,  with  the  addition  of  a  small  quantity  of  the 
tinctura  camphoraj  composit.,  and  by  persisting  in  its  use  for  several  weeks,  the 
urine  became  less  turbid,  and  the  pain  and  frequent  desire  to  make  water  gradu- 
ally left  him;  and,  at  the  distance  of  two  months  from  the  day  he  commenced 
the  benzoic  acid,  he  described  himself  as  free  from  his  troublesome  symptoms, 
and  is  at  this  time  improved  in  his  general  health,  in  a  manner  which  has  sur- 
prised as  well  as  gratified  all  who  knew  him." 

Mr.  J.  S.  SoDEN  of  Bath  has  been  induced,  by  Mr.  Walker's  representations, 
to  try  the  effects  of  the  combination  of  benzoic  acid  and  balsam  copaiba  in  cer- 
tain affections  of  the  urinary  organs,  and  the  results  of  his  trials  are  entirely  in 
favour  of  its  efficacy,  as  the  following  cases  related  by  him  in  the  Prov.  Med. 
and  Surg.  Journ.,  July  30,  1842,  will  testify. 

"  I  was  summoned  to  an  elderly  gentleman  who  had  long  suffered  from  irri- 
table bladder  and  enlarged  prostate.  Three  years  ago  1  saw  this  patient  on  ac- 
count of  retention  of  urine.  I  was  then  informed  that,  for  a  considerable  time, 
he  had  had  frequent  inclination  to  pass  urine,  though  able  to  void  only  a  small 
quantity  at  each  call,  and  that  the  urine  was  generally  loaded  with  mucous  secre- 
tion. 1  found  enlargement  of  the  prostate,  but  had  no  difficulty  in  passing  a 
catheter;  [  emptied  his  bladder,  and  the  urine  drawn  off  contained  a  considerable 
quantity  of  muco-purulent  deposit.  The  catheter  was  passed  daily,  and  the 
bladder  washed  out  with  warm  water;  the  hip-bath,  with  rest,  and  the  means 
ordinarily  adopted  in  such  cases,  soon  mitigated  the  severity  of  this  attack.  The 
patient  acquired  the  power  of  introducing  the  catheter  himself,  and  has  used  the 
instrument,  I  believe,  daily  ever  since  that  period.  I  occasionally  felt  the  in- 
strument strike  against  a  calculus,  but  the  state  of  the  prostate,  and  advanced 
age  of  the  individual,  rendered  an  operation  inadvisable.  During  the  last  three 
years  he  has  taken  most  of  the  remedies  generally  recommended  on  such  occa- 
sions, and  thinks  the  uva  ursi  has  been  most  serviceable  to  him.  He  had  not, 
for  a  long  time,  been  under  the  care  of  a  medical  man,  but  trusted  entirely  to  his 
own  management,  till  I  was  sent  for  in  March  last  in  consequence  of  aggrava- 
tion of  suffering.  He  showed  me  the  urine  he  had  recently  passed  and  drawn 
off.  It  deposited  a  large  quantity  of  muco-purulent  discharge.  He  complained 
much  of  the  irritability  of  the  bladder.  I  injected  warm  water,  and,  as  on  for- 
mer occasions,  he  had  derived  more  benefit  from  the  exhibition  of  uva  ursi 
than  from  any  other  remedy,  I  prescribed  that  medicine,  together  with  the  use 
of  the  hip-bath,  and  a  suitable  regimen;  as  no  material  relief  ensued  at  the  end 
of  three  days,  I  directed  the  benzoic  acid  in  the  following  form: — 

Benzoic  acid,  one  drachm;  balsam  of  copaiba,  half  an  ounce;  yolk  of  egg, 
enough  to  form  a  mixture  with  seven  ounces  of  camphor  mixture.  Two  table- 
spoonfuls  to  be  taken  thrice  a-day. 

I  never  witnessed  anything  equal  to  the  eflScacy  of  this  medicine;  the  urine 
became  clearer  after  the  first  dose,  and  in  two  days  it  was  perfectly  free  from 
mucous  deposit,  the  irritability  of  the  bladder  was  lessened,  and  in  four  days 
the  patient  resumed  his  self-management.  I  did  not  feel  the  calculus  during 
this  attendance.  The  gentleman  left  Bath  about  six  weeks  after  this  period. 
I  saw  him  a  few  days  before  his  departure;  he  told  me  that  he  was  as  well  as 
usual,  that  he  continued  to  use  the  catheter,  but  that  the  urine  was  quite  clear, 
and  that  when  he  observed  any  tendency  to  mucous  deposit  he  had  recourse  to 
the  mixture,  and  always  with  success. 

The  result  of  this  case  induced  me  to  give  the  medicine  a  trial  at  the  United 
Hospital,  and  our  intelligent  house-surgeon,  Mr.  Morgan,  has  been  kind  enough 
to  give  me  the  heads  of  four  cases  in  which  it  has  been  exhibited  at  that  institu- 
tion. 


472  Progress  of  the  Medical  Sciences.  [Oct. 

Case  I. — A  man,  aged  thirty-five,  applied  for  admission  as  an  out-patient, 
complaining  of  frequent  desire  to  make  water,  which  has  existed  for  the  last 
month;  the  urine  deposits  mucous  sediment;  the  patient  has  no  gonorrhcea,  and 
refers  his  disorder  to  being  much  exposed  to  cold  and  wet.  On  passing  a  cathe- 
ter the  urethra  was  found  perfectl)'  natural,  but  there  was  some  slight  hemor- 
rhage after  the  urine  had  been  evacuated;  has  some  pain  in  the  loins;  pulse 
rather  strong;  was  at  first  cupped  on  the  loins,  and  ordered  aperients,  and  then 
diosma  and  the  pareira  brava,  with  opiates,  were  given  in  succession.  After 
having  attended  for  three  weeks,  he  complained  of  some  pain  in  the  joints,  for 
which  he  was  ordered  colchicum,  and  though  it  greatly  relieved  the  rheumatic 
afi^ection,  produced  no  beneficial  effect  upon  the  state  of  the  bladder.  Mr.  Soden 
saw  him,  and  directed  the  mixture,  with  benzoic  acid  and  balsam  of  copaiba. 
He  found  benefit  after  using  it  for  two  days,  and  in  ten  days  was  perfectly 
well. 

Case  II. — A  married  woman,  apparently  in  good  health,  was  admitted  as  an 
out-patient,  stating  that  she  had  frequent  desire  to  make  water;  the  urine  depo- 
siting on  cooling  (she  says)  a  whitish  sediment;  urine  slightly  acid;  she  has 
been  under  medical  treatment  at  intervals  during  the  last  six  months,  but  with- 
out deriving  any  benefit  from  the  means  adopted.  The  mixture,  with  benzoic 
acid  and  balsam  of  copaiba,  was  ordered  immediately,  and  she  was  discharged, 
cured,  in  three  weeks. 

Case  III, — A  man,  aged  fifty,  has  been  under  the  care  of  two  surgeons  for  a 
month,  owing  to  having  suffered  from  irritability  of  the  bladder.  Has  now  fre- 
quent desire  to  make  water;  a  small  quantity  of  blood  is  occasionally  passed 
with  the  last  drop  of  urine;  some^ropy  mucus  is  deposited  in  the  urine,  which  is 
slightly  acid,  though  it  very  soon  becomes  ammoniacal  on  standing;  there  is 
some  irritation  at  the  glans  penis;  on  sounding,  no  stone  could  be  detected.  He 
was  ordered  the  benzoic  acid  mixture,  but  only  continued  his  attendance  for 
three  visits  (eight  days),  during  which  time  great  relief  was  afforded,  and  as 
he  has  not  since  applied  at  the  hospital,  he  is  most  probably  M^ell. 

Case  IV. — A  man,  aged  thirty-seven,  after  a  severe  attack  of  gonorrhoBa,  which 
appeared,  by  his  description,  to  have  been  attended  with  acute  inflammation  of 
the  bladder,  was  admitted  an  out-patient.  He  complains  of  being  obliged  to 
make  water  very  frequently,  having  to  get  up  six  or  eight  times  in  the  night  to 
empty  his  bladder;  has  much  pain  in  front  of  the  pubis;  some  ropy  mucus  is 
deposited  in  the  vessel,  after  the  urine  has  been  standing  some  time.  After  try- 
ing several  other  remedies  without  advantage,  the  benzoic  acid  mixture  was 
ordered,  from  the  use  of  which  he  experienced  great  relief  in  two  or  three  days, 
and  at  the  end  of  ten  days  no  mucus  was  discovered  in  the  urine. 

The  most  remarkable  circumstance  connected  with  the  exhibition  of  this  medi- 
cine, as  far  as  my  experience  goes,  is  its  decided  efficacy  in  diminishing,  and, 
in  some  instances,  completely  suppressing  the  muco-purulent  deposition  in  the 
urine,  which  is  so  prominent  a  symptom  in  most  cases  of  affection  of  the  blad- 
der. I  am  aware  that  a  doubt  may  be  very  fairly  entertained  whether  this  effect 
is  to  be  attributed  to  the  benzoic  acid,  or  to  the  balsam  of  copaiba,  or  to  their 
combination. 

36.  Post-mortem  Examination  of  the  Duke  of  Orleans. — The  accuracy  of  the 
following  details  may  be  relied  on.  It  will  be  seen  that  the  Prince  died  in  con- 
sequence of  a  crushing  (ecrasement)  of  the  head,  to  use  the  phrase  employed  by 
Dupuytren  in  his  clinical  lectures  to  designate  the  severest  and  most  complex 
physical  lesions. 

In  fact,  this  injury  combines  contusion,  laceration,  rupture,  and  fracture,  and 
we  may  add  luxation— that  is  to  say,  separation  of  the  sutures.  The  Prince 
consequenily  suffered  every  possible  physical  injury  of  the  head. 

These  crushes,  without  division  of  the  skin,  are  usually  caused  by  a  blow  of  a 
beam  of  timber,  or  heavy  mass  of  stone — by  the  passage  of  a  heavily  laden 
waggon  over  the  head — by  a  horse  falling  on  his  rider,  and  particularly  by  a 
cannon-ball  striking  the  head  obliquely.     Similar  injury  occasionally  results 


1842.]  Surgery,  473 

from  a  fall,  provided  it  be  from  a  very  great  height,  and  that  the  head  first 
strikes  the  ground.  But  the  carriage  of  the  Prince  was  a  very  low  one;  and 
therefore  he  must  have  been  projected  with  a  very  considerable  impulse,  as  the 
mere  weight  of  the  body  falling  such  an  inconsiderable  height  could  not  account 
for  such  numerous  fractures — such  extensive  mischief.  Further,  the  two  forces 
must  have  been  so  directed  that  the  head  sustained  almost  the  entire  shock;  or 
else  we  must  suppose  that  there  was  extreme  fragility  of  the  bones. 

Examination  of  the  body  forty  hours  after  death,  by  Dr.  Pasquier,  first  surgeon 
to  the  Prince  Royal,  assisted  by  M.  Pasquier,  first  surgeon  to  the  king,  and 
MM.  Fouquier,  Anvity,  Moreau,  Blandin,  Blache,  Destouches,  Sauve,  and 
Seguin* 

External  appearances. — Commencement  of  putrefaction,  especially  over  the 
abdomen,  and  on  the  posterior  part  of  the  trunk.  Cadaveric  rigidity  of  the 
limbs.  Contusions  on  the  right  jaw,  the  right  eyebrow,  and  right  side  of  the 
forehead.  Extensive  bloody  tumour  on  the  back  and  right  side  of  the  head. 
Traces  of  contusion  on  the  front  of  the  knees,  on  the  left  hand,  and  over  the  left 
trochanter. 

Sanguineous  infiltration  of  the  soft  parts  covering  the  superior,  posterior,  and 
lateral  regions  of  the  head,  especially  posteriorly,  and  on  the  right  side. 

Separation  of  the  lambdoidal  suture,  of  the  squamous  sutures,  the  left  mas- 
toidal suture,  the  sphenoidal,  and  both  spheno-petrous  sutures.  Numerous  frac- 
tures, which  may  be  divided  into  three  series. 

1.  Right  side  of  head. — A  fracture  commenced  at  the  right  side  of  the  lamb- 
doidal suture,  passed  a  little  above  the  posterior  and  inferior  angle  of  the  parietal 
bone,  through  the  squamous  portion  of  the  temporal  bone,  extended  into  the 
temporal  fossae,  and  terminated  on  the  great  wing  of  the  sphenoid  bone. 

2.  Left  side  of  head. — Another  fracture  commenced  at  the  left  side  of  the 
lambdoidal  suture,  divided  the  parietal  bone  from  behind  forward  in  half  its 
extent,  and  separated  from  behind  forward  the  scaly  portion  of  the  temporal 
from  the  rest  of  the  bone;  the  squamous  suture  being,  as  has  been  already 
stated,  disunited;  this  portion  of  the  bone  adhered  to  the  soft  parts  only, 

3.  A  third  fracture  divided  the  sphenoid  bone  transversely  at  the  level  of  the 
sella  turcica. 

These  fractures,  together  with  the  disunion  of  the  sutures,  separated  the 
cranium  into  two  portions,  viz: — 1st.  Anterior  and  superior  portion  comprising 
from  before  backward,  the  superior  portions  of  the  parietal  bones,  the  squamous 
portion  of  the  temporal  bones,  the  frontal,  the  ethmoid,  and  almost  the  entire  of 
the  sphenoid  bones.  2d.  A  posterior  and  inferior  portion,  comprehending  the 
inferior  parts  of  the  temporal  and  parietal  bones,  and  the  posterior  parts  of  the 
sphenoid.  These  two  portions  of  the  cranium  admitted  of  considerable  motion 
on  each  other. 

The  brain  was  very  large.  Its  anterior  inferior  part,  to  the  level  of  the  fissure 
of  Sylvius,  was  reduced  into  a  reddish  pulp  as  far  as  the  bottom  of  the  anfrac- 
tuosities.  A  similar  alteration,  but  much  more  limited  in  extent,  existed  behind 
and  on  the  right  side.  There  was  considerable  effusion  of  blood  into  the  cavity 
of  the  arachnoid,  and  the  sub-arachnoid  tissue  presented  a  very  decided  sangui- 
neous infiltration.  A  few  drops  of  reddish  serum  were  found  in  the  ventricles. 
The  spinal  marrow  and  vertebral  column  were  uninjured. 

There  was  effusion  of  blood  into  the  pleura.  The  lungs  were  gorged  with 
blood;  but  were  perfectly  free  from  any  adhesion.  The  heart  and  pericardium 
were  natural.     The  abdominal  viscerae  were  sound. 

After  the  examination,  the  body  was  embalmed  according  to  the  Egyptian 
method. — Dublin  Med.  Press,  July  27,  1842,  from  Gazette  des  Hopitaux,  July  19, 
1842. 

37.  Caries  of  the  tenth  and  eleventh  Ribs, — excision, — cure. — M.  Jacquet  relates 
in  the  Ann.  de  la  Soc.  des  Sc.  Nat.  et  Med.  de  Bruxelles,  (1841,)  the  following 
case: — Pierre  Vilain,  a  labourer,  ajtat.  48,  had,  when  13  years  old,  his  10th  and 
11th  ribs  of  the  right  side  fractured,  from  a  blow  with  a  pitchrfork.     The  bones 

40* 


474  Progress  of  the  Medical  Sciences.  [Oct. 

united,  but  considerable  thickening  remained  over  the  seat  of  injury.  This  in- 
creased to  the  size  of  a  pigeon's  eg-g,  and  from  time  to  time  he  suffered  from 
dyspncea.  He  continued  to  labour  at  his  work  till  1840,  when,  from  the  mag- 
nitude that  the  tumour  had  acquired,  viz.  that  of  a  fist,  and  the  increasing 
dyspncea,  he  was  obliged  to  apply  for  relief.  The  tumour  became  inflamed, 
and  suppurated,  and  five  fistulas  formed.  It  was  then  evident  that  the  10th  and 
11th  ribs  were  much  hypertrophied,  and  in  a  state  of  caries.  His  health  began 
to  suffer.  M.  Jacquet  was  then  consulted.  Having  ascertained  that  the  lungs 
were  healthy,  and  considering  that  the  constitution  was  only  suffering  from  the 
local  affection,  he  determined  to  remove  the  diseased  portion  of  the  ribs,  which 
he  accordingly  did  on  the  7th  of  April,  1840.  The  bones  were  exposed,  and 
divided  by  means  of  the  cutting  pliers.  The  pleura  was  opened,  but  no  untoward 
result  followed,  and  in  two  months  the  cure  was  completed,  and  the  patient  in 
good  health.  In  reading  this  paper  before  the  Society  of  Natural  and  Medical 
Sciences  of  Brussels,  M.  Jacquet  presented  for  the  inspection  of  the  members, 
both  his  patient,  and  the  pieces  of  bone  which  he  had  removed. — Lond.  and 
Edin.  Monthly  Journ.  Med.  Set.  Aug.  1842. 

38.  Superficial  Cancers. — M.  Lisfranc  has  published  a  series  of  cases  of  can- 
cer, in  which  under  ordinary  circumstances  it  would  have  been  necessary  to 
remove  the  diseased  organs,  but  which,  he  has  shown,  admit  of  permanent  cure 
by  the  simple  ablation  of  the  part  of  the  organ  which  is  diseased.  The  first 
case  he  mentions  is  that  of  a  man  who  consulted  him  in  1826,  having  a  cancer- 
ous tumour,  about  half  an  inch  thick,  surrounding  the  penis  behind  the  glans; 
its  anterio-posterior  diameter  was  about  two  inches.  It  was  ulcerated,  immova- 
ble, and  adherent,  and  presented  all  the  characteristics  of  cancer.  As  the  re- 
moval of  the  penis  is  an  operation  to  which  the  greatest  repugnance  is  always 
manifested,  Lisfranc  decided  on  making  an  exploratory  incision,  and  by  a  careful 
and  slow  dissection  lay  bare  the  corpora  cavernosa;  if  they  were  sound  he  would 
then  proceed  to  extirpate  the  diseased  growth,  if  not,  he  would  amputate  the 
penis.  The  additional  pain  of  this  proceeding  would  be  well  compensated  by 
the  prospect  of  retaining  so  important  an  organ.  The  operation  succeeded  re- 
markably well;  the  cavernous  structure  was  healthy,  only  a  small  portion  of  the 
fibrous  covering  of  the  penis,  where  ulceration  had  taken  place,  being  engaged 
in  the  disease,  which  was  removed.  The  patient  had  not  a  bad  symptom  after- 
wards, and  recovered  perfectly  in  the  course  of  three  weeks.  He  showed  him- 
self to  Lisfranc  several  times  afterwards,  and  assured  him  he  was  perfectly  com- 
petent to  perform  all  his  duties. 

The  successful  termination  of  this  case  encouraged  the  surgeon  to  proceed  in 
like  manner  wiih  a  patient  who  laboured  under  a  cancer  of  greater  extent.  It 
occupied  the  anterior  portion  of  the  scrotum,  and  about  two  inches  of  the  skin 
of  the  root  of  the  penis,  and  the  posterior  half  of  that  organ.  Every  part  was 
ulcerated,  and  the  disease  was  of  long  standing.  By  a  careful,  slow,  and  labo- 
rious dissection,  the  testicles  and  spermatic  cords  were  uncovered;  the  cancerous 
portion  of  the  scrotum  being  cut  away,  the  next  step  was  to  make  a  similar  ex- 
ploration of  the  penis,  which  being  done,  showed  that  the  superior  ligament  was 
diseased,  and  must  be  removed.  The  carcinoma  extended  as  far  as  the  re-union 
of  the  corpora  cavernosa,  which  were  necessarily  denuded  as  for  an  anatomical 
lecture,  and  even  then  it  w^as  requisite  to  scrape  them  with  a  bistoury  to  remove 
all  traces  of  the  disease.  The  patient  recovered  in  rather  less  than  seven  weeks, 
preserving  the  virile  power. 

Cancer  of  the  tongue  has  hitherto  been  treated  by  the  ablation  of  the  organ; 
but  Lisfranc  has  demonstrated  that,  in  some  cases  at  least,  the  disease  is  super- 
ficial, and  may  be  removed  without  permanent  injury  to  the  organ.  He  nar- 
rates the  case  of  a  young  advocate,  who  was  under  his  care  in  September,  1826, 
for  an  ulcerated  cancer  occupying  the  two-thirds  of  the  right  side  of  the  tongue. 
Its  ablation  had  been  advised  by  several  eminent  surgeons,  but  Lisfranc  decided 
otherwise.  He  separated  the  diseased  from  the  healthy  structure,  and  surround- 
ed the  former  with  a  ligature,  which  was  tightened  by  Mayor's  tourniquet. 


1842.]  Si&gery,  475 

The  constriction  was  gradually  increased,  and  on  the  seventh  day,  the  slouch 
having  separated,  there  was  a  loss  of  only  two  lines  in  extent  of  the  point  of 
the  tongue.  The  surface  only  was  diseased;  the  deeper  tissues  were  healthy, 
and  cicatrised.  This  patient  was  seen  hy  Lisfranc  three  years  after  the  opera- 
tion, and  no  relapse  had  occurred. 

Several  other  cases  are  recorded  by  this  talented  surgeon,  including  cancer  of 
the  penis  and  vagina,  of  the  ala  nasi,  the  eyelids,  the  loins,  the  finger,  &e.,  in 
all  of  which  the  primary  exploratory  incision  showed  clearly  that  the  disease 
was  superficial,  and  admitted  of  its  total  ablation,  without  the  absolute  destruc- 
tion of  the  organ  itself.  At  the  same  time  Lisfranc  states,  that  while  some  of 
these  cancers  are  regarded  as  deep-seated  erroneously,  the  latter  condition  may 
exist,  and  require  the  complete  amputation  of  the  part. — Prav,  Med.  Journ, 
July  30th,  1842,  from  Clmique  Chirur gicale. 

39.  Ununited  Fracture  of  the  Humerus  cured  hy  the  insertion  of  a  seton  at  two 
different  periods.  By  MM.  Mawroury  and  Thore. — A  young  woman,  2'J  years 
of  age,  in  November,  1840,  fell  a  height  of  three  metres,  upon  her  left  elbow, 
and  met  with  a  compound  fracture  of  the  humerus  at  the  middle.  The  arm  was 
not  properly  put  up  until  the  following  day,  when  she  entered  the  hospital. 
Splints  and  a  roller  were  applied,  which  were  removed  daily  in  order  to  dress 
the  wound,  so  that  considerable  motion  of  the  fractured  extremities  took  place. 
As  there  was  no  appearance  of  union  at  the  end  of  30  days,  the  starch  bandage 
was  employed,  but  in  such  a  manner  as  to  leave  the  wound  exposed.  Having 
derived  no  benefit  from  this  treatment  in  4^  months,  and  as  she  was  suffering 
great  pain,  and  believed  at  the  time  that  her  case  was  incurable,  she  left  the 
hospital,  but  returned  in  six  weeks  to  the  Hotel  Dieu.  She  then  came  under  the 
care  of  M.  Roux.  She  was  still  in  good  health,  the  wound  in  the  arm  discharged 
freely,  but  she  felt  great  pain.  Upon  examining  the  arm,  M.  Roux  discovered 
a  fragment  of  bone  lying  between  the  fractured  extremities.  This  he  removed, 
and  at  the  same  time  passed  a  seton  between  the  broken  surfaces;  it  was  kept 
inserted  for  eight  days.  The  arm  was  then  kept  immovable  by  the  starch  band- 
age for  four  months,  but  at  the  end  of  this  period  it  was  still  quite  flexible. 
She  then  left  the  hospital  for  a  month.  When  she  returned,  she  was  under  the 
care  of  M.  Maisonneuve,  who  at  that  time  was  taking  charge  of  M.  Roux's 
patients.  M.  M.  passed  another  seton  considerably  thicker  than  the  first  one, 
and  allowed  it  to  remain  for  fifteen  days.  General  tumefaction  of  the  arm  followed, 
and  pus  flowed  from  the  wound,  both  of  which  soon  subsided  after  the  removal 
of  the  cord.  In  two  months  there  was  hardly  any  mobility,  and  at  the  end  of 
three,  the  patient  experienced  the  sensation  as  if  the  arm  was  firm.  When  she 
left  the  hospital  six  weeks  after,  she  was  still  unable  to  lift  the  arm;  but  upon 
being  visited  in  three  weeks,  a  solid  osseous  deposit  round  the  fracture  was  felt, 
there  was  also  great  stiflTness  of  the  elbow  and  wrist  joints. — Lond.  and  Edin^ 
Month.  Journ.  Aug.  1842,  from  Gaz.  Med.  de  Paris,  25  June,  1842. 

40.  Tumours  in  the  Bladder. — Mr.  Douglas  relates  a  very  interesting  series 
of  cases  of  tumours  in  the  bladder,  which  he  has  collected  from  various  sources. 
The  most  important  point  he  illustrates,  is  the  possibility  of  their  becoming  so 
incrusted  with  calcareous  deposit  from  the  urine,  as  to  be  mistaken  and  operated 
on  for  stone,  if  sufficient  care  be  not  taken  in  the  examination.  He  relates  one 
case  occurring  in  the  Glasgow  Infirmary,  where  this  mistake  actually  took  place, 
and  where  an  instrument  was  introduced  to  crush  the  supposed  calculus,  whereby 
a  portion  of  the  tumour  was  detached,  and  was  found  lying  loose  in  the  bladder 
after  death,  which  took  place  from  inflammation.  Such  cases  are  to  be  distin- 
guished by  the  absence  of  the  ringing  sound,  and  of  the  firm  distinct  feeling  of 
contact  of  the  instrument  against  a  hard  body,  which  alone  should  warrant  our 
operating  in  cases  of  stone. — Lond.  and  Edin.  Monthly  Journ.  Med.  Sci.  July, 
1842,  from  Lond.  Med.  Gaz.  Feb.  4,  1842. 


476  Progress  of  the  Medical  Sciences,  [Oct. 

.41.  Scriveners'  Spasm  cured  hy  division  of  Muscles.  By  Prof.  Stromeyer. — 
This  disease,  which  may  be  familiarly  called  Scriveners'  spasm,  and  consists  in 
permanent  contraction  of  the  long-  flexor  of  the  thumb,  is  not  very  rare.  Several 
cases  have  been  published  in  Germany  by  Albers,  Heyfelder,  and  Kopp;  and  in 
France  by  Cazenave  and  David.  The  chief  characteristic  of  this  affection  is 
an  absolute  incapability  of  using-  the  pen,  for  vv^riling,  although  the  strength  and 
motions  of  the  hand  remain  unimpaired  for  all  other  purposes.  Some  authors 
regard  it  as  a  species  of  spasm;  others,  as  depending  on  paralysis;  it  is  gene- 
rally permanent,  but  occasionally  appears  at  intervals,  and  then  is  commonly 
brought  on  by  long  continued  use  of  the  pen.  This  affection,  though  apparently 
slight,  is  most  obstinate,  and  resists  every  method  of  treatment  that  has  hitherto 
been  employed  against  it.  The  following  cases,  which  we  abridge  considerably, 
had  baffled  the  skill  of  Professor  Stromeyer,  until  he  had  recourse  to  division  of 
the  flexor  muscle,  which  was  attended  with  complete  success. 

Case  I. — J.  M.,  a  public  writer  at  Hanover,  laboured  under  this  disease 
during  two  years.  A  celebrated  physician  had  tried  every  kind  of  remedy  with- 
out avail.  Whenever  he  began  to'  write  the  muscles  of  the  ball  of  the  thumb 
were  seized  with  spasm,  which  compelled  him  to  desist,  but  the  spasms  did  not 
appear  at  any  other  time.  M.  Stromeyer  also  tried  a  variety  of  means  ineffect- 
ually, and  then  divided  the  small  flexor  muscles  of  the  thumb.  This  likewise 
failed,  and  the  sensibility  of  the  palmar  surface  of  the  thumb  was  destroyed. 
It  was  now  clear  that  the  action  of  writing  depended  on  the  long  flexor,  but  the 
patient  refused  to  permit  any  more  operations  to  be  performed  on  him. 

Case  II. — The  subject  of  this  case  had  suffered  under  the  disease  for  fifteen 
years,  when  first  seen  by  M.  Stromeyer.  The  rigidity  of  the  muscles  of  the 
ball  of  the  thumb  was  not,  however,  present,  but  the  last  phalanx  of  the  thumb 
became  suddenly  flexed,  whenever  the  patient  attempted  to  write  or  play  on  the 
piano. 

The  long  flexor  was  not  permanently  contracted,  nor  did  it  impede  any  other 
motions  of  the  hand.  From  the  deep  situation  of  the  muscle  it  was  not  easy  to 
divide  it  separately.  M.  Stromeyer  bent  the  first  phalanx  strongly  to  a  right 
angle,  and  at  the  same  time  turned  the  thumb  as  much  out  as  possible;  he  then 
passed  a  very  small,  curved  tenotome  underneath  the  tendon,  and  divided  it. 
The  sensibility  of  the  thumb  was  very  considerably  diminished  after  the  opera- 
ration,  but  was  restored,  on  the  dorsal  aspect  the  next  day,  and  on  the  palmar 
aspect  within  a  fortnight.  The  natural  power  of  moving  the  thumb,  also, 
returned  at  the  latter  period,  and  the  patient  was  able  to  write  or  play  on  the 
piano  without  the  slightest  return  of  the  spasm. — Prov,  Med.  and  Surg.  Journ, 
Feb.  5,  1842,  from  Arch.  Gen.  de  Med.  Jan.  1842. 

42.  Tumours  developed  on  Cicatrices. — At  a  meeting  of  the  Academy  of  Medi- 
cine on  the  29th  of  March,  M.  Gimelle  presented  a  soldier  who  had  received 
seven  blows  of  the  yatagan  on  different  parts  of  his  body,  and  over  the  wounds 
resulting  from  which,  tumours  of  a  red,  flattened,  and  pediculated  character, 
had  formed.  They  bore  some  resemblance  to  mushrooms.  The  patient  had 
never  had  syphilis.  M.  G.,  not  being  certain  of  the  nature  and  treatment  of 
these  tumours,  requested  the  opinion  and  advice  of  members  of  the  society. 
In  the  course  of  the  discussion  that  ensued,  M.  Velpeau  said,  that  they  appeared 
to  him  to  present  the  characters  of  the  heloide  described  by  M.  Alibert.  These 
tumours,  according  to  M.  A.,  are  somewhat  hard,  of  a  pale  red  colour,  flattened, 
in  the  form  of  plates,  and  present  a  homogeneous  cup-like  shape,  all  which, 
correspond  with  the  tumours  on  the  soldier.  Like  scirrhus,  when  excised,  a 
portion  of  the  sound  integument  must  be  removed  with  them,  but  even  then 
they  are  apt  to  return.  M.  Gerdy  remarked,  that  there  were  only  two  hypotheses 
about  the  nature  of  the  disease;  the  one  was  that  maintained  by  M.  Velpeau, 
the  other  was,  that  they  were  merely  fungous  vegetations,  which  had  not  been 
kept  under  during  the  cicatrization  of  the  wounds.  He  believed  that  they  came 
under  the  latter  description. 

M.  Patissier  mentioned,  that  he  had  seen  similar  tumours  always  produced 


1842.]  Surgery,  47T 

in  a  patient  after  the  application  of  leeches.  M.  Rochoux  had  seen  vegetations 
of  a  like  nature  on  the  lobes  of  the  ears  of  mulattoes  who  wore  long  ear-rings. 
M.  Blandin  thought  that  the  best  mode  of  treatment  was  to  excise  them,  cau- 
terize their  base,  and  then  use  compression;  the  latter  was  alone  sometimes 
found  sufficient. — The  majority  of  members  seemed  to  think  that  they  were 
more  of  the  nature  of  fungous  vegetations  than  of  the  heloide  tumour. — Lond. 
and  Edin,  Monthly  Journ.  Med.  Set.  July  1842,  from  Gaz.  Med.  de  Paris,  April 
2,  1842. 

43.  Fracture  of  Cranium  with  considerable  loss  of  the  Substance  of  the  Brain. — 
Dr.  Zartmann  of  Bonn,  relates  in  the  Organ  fur  die  gesammte  Heilkunde,  (Vol. 
i.  No.  4,)  the  following  example  of  this. 

A  robust  man,  28  years  of  age,  fired  off  a  gun  containing  a  double  charge;  it 
burst,  and  a  portion  of  the  barrel  penetrated  the  right  side  of  the  frontal  bone. 
It  was  immediately  withdrawn  by  his  companions.  Half  an  hour  after  the 
accident,  he  was  examined  by  a  surgeon,  who  found  him  with  all  his  intel- 
lectual faculties  sound,  and  only  complaining  of  slight  headache,  and  stiffness 
of  the  back  of  the  neck.  Above  the  right  orbit,  and  about  half  an  inch  from  the 
frontal  protuberance,  was  a  wound,  from  which  the  white  or  grey  matter  of  the 
brain  was  escaping,  but  little  or  no  blood.  The  finger  could  be  introduced  to 
the  depth  of  nine  lines,  and  the  brain,  along  with  many  splinters  of  bone,  could 
be  felt.  The  opening  was  round  and  notched,  the  internal  membranes  were 
detached,  and  the  pulsations  of  the  cerebrum  were  distinctly  seen.  The  pulse 
was  small,  frequent,  but  regular,  and  the  skin  was  cold.  He  was  bled  to  ^xxx, 
and  was  ordered  to  get  a  saline  mixture,  and  to  have  cold  cloths  applied  to  his 
head.  On  the  next  day,  the  cerebral  substance,  mixed  with  blood  and  small 
pieces  of  bone,  still  issued  from  the  wound.  He  complained  of  violent  head- 
ache, but  otherwise  was  well.  Was  again  bled.  On  the  second  day  from  the 
accident  there  was  little  discharge  from  the  wound,  but  its  edges  were  swollen 
and  inflamed,  and  the  symptoms  of  inflammation  of  the  brain  were  well  deve- 
loped, as  want  of  sleep,  restlessness,  headache,  strong  pulsation  of  the  carotids 
and  temporals,  &c.  To  be  bled  to  ^x,  to  have  twelve  leeches  on  the  wound,  ice 
on  the  head,  a  saline  mixture,  and  sinapisms  to  the  calves  of  the  legs.  Third  day, 
the  inflammatory  symptoms  less  marked.  Continue  the  ice,  and  to  have  two 
grains  of  calomel  every  two  hours.  Fourth  day,  still  improving.  By  the  end 
of  the  week,  the  suppuration  from  the  wound  was  healthy,  and  the  granulations 
beginning  to  appear.  The  cure  was  completed  in  a  month.  Not  the  slightest 
alteration  was  visible  in  his  intellectual  faculties,  although  the  brain  must  have 
lost  at  least  three  ounces  of  its  substance. — Lond.  and  Edin.  Monthly  Journ. 
Med.  Set.  July  1842,  from  Gaz.  Med.  de  Paris,  Feb.  12,  1842. 

44.  Ligature  of  the  subclavian  and  arteria  innominata  arteries  for  wound  in  the 
arm  pit. — A  case  of  this  is  related  by  M.  Hutin  in  the  Ann.  de  Chirurg.  Fran- 
caise.  The  wound  had  been  made  with  a  large  pair  of  scissors.  On  removing 
the  dressing,  twelve  days  after  the  infliction  of  the  wound,  arterial  blood,  in  a 
stream  about  the  thickness  of  a  pen,  spirted  from  the  cavity.  As  none  of  the 
applications  had  recourse  to,  arrested  the  hemorrhage,  M.  Hutin  proceeded  to 
tie  the  subclavian,  which  he  did  external  to  the  scaleni  muscles.  The  bleeding 
immediately  ceased,  and  the  pulse  could  not  be  felt  at  the  wrist.  Six  days  after 
the  ligature  of  the  artery,  the  hemorrhage  recurred,  but  to  a  small  extent.  On 
the  day  following,  there  was  also  a  little.  On  the  ninth  day,  the  ligature  came 
away,  and  in  the  evening,  after  a  fit  of  coughing,  there  was  a  jet  of  arterial  blood 
from  the  subclavian.  It  was  then  considered  necessary  to  tie  the  innominata, 
which  was  done  at  midnight.  The  operation,  which  is  said  to  have  been  well 
performed,  was  long  and  painful.  The  patient,  however,  sank  in  twelve  hours 
after.  At  the  post-mortem  examination,  the  ligature  was  found  to  have  been 
placed  round  the  innominata,  about  a  centimetre  at  most  from  its  bifurcation, 
and  none  of  the  important  parts  in  the  neighbourhood  were  injured.  The  sub- 
clavian was  divided  about  thirty  millimetres  from  the  nearest  branch;  its  ex- 


476  Progress  of  the  Medical  Sciences,  [Oct. 

tremities  were  dosed  by  a  clot  more  than  a  centimetre  in  length.  The  blood 
had  escaped  from  the  upper  end  of  the  artery,  or  that  extremity  next  the  heart. 
The  axilla  artery  was  entire,  but  the  inferior  thoracic  was  completely  divided 
about  a  centimetre  from  its  origin. — Nothing,  not  even  congestion,  was  found  in 
the  lungs  or  brain. — Lond.  and Edin.  Month.  Journ,  Aug.  1842. 

45.  Nature  and  Treatment  of  common  Toothache. — Mr.  T.  Wilkinson  King 
lays  it  down  as  a  principle,  that  carious  teeth  ought  not  to  be  removed,  and  that 
their  loss  is  fraught  with  mischief.  Toothache  is,  in  his  view,  a  disturbance 
of  the  balance  of  the  capillary  circulation  in  the  central  cavity  of  the  tooth, 
whether  produced  by  local  irritation  or  disturbance  in  the  general  system.  It  is 
connected  with  decay  in  the  hard  substance  only  thus  far,  that  by  means  of  this 
decay  a  communication  is  established  between  the  central  cavity  of  the  tooth 
and  the  external  air,  in  consequence  of  which  its  vascular  and  sensitive  lining 
becomes  susceptible  of  pain,  and  subject  to  foreign  impressions.  No  longer 
confined  within  unyielding  walls,  it  now  becomes  capable  of  unusual  vascular 
injection  and  tumefaction;  and  while  especially  liable  to  disturbing  influences 
from  without,  such  as  pressure,  change  of  temperature,  local  stimuli,  &c.  is  also 
in  a  situation  to  be  affected  by  those  constitutional  disturbances,  whereby  the 
balance  of  the  capillary  circulation  is  deranged,  and  determinations  of  blood  to 
particular  parts  produced.  Our  object  in  curing  toothache  must,  if  these  views 
are  correct,  be  to  restore  the  balance  of  the  capillary  circulation.  The  means 
which  the  author  recommends  to  effect  this  purpose  are  threefold.  First,  those 
which  locally  contract  the  capillaries,  as  camphorated  spirit,  &c.,  and  if  the 
affected  spot  be  both  accessible  and  limited,  our  attempts  will  generally  prove 
successful,  at  least  for  a  time.  Next  should  be  considered,  if  need  be,  the 
means  of  diverting  the  capillary  fulness  to  other  parts  of  the  body — for  which 
purpose  he  recommends  warmth,  diffusible  and  local  stimuli,  purging,  diapho- 
resis, fasting,  &c.  Lastly,  we  must  seek  to  prevent  a  recurrence  of  the  attack, 
by  promoting  the  free  nutrition  of  the  capillary  system,  by  means  of  a  some- 
what stimulant  and  limited  diet.  Thus  the  tone  of  the  vessels  will  be  restored, 
and  a  power  of  resistance  communicated  to  them  against  the  constant  causes 
of  disturbance  to  which  they  will  continue  exposed.  Though  too  commonly 
altogether  neglected,  it  is  only  by  attention  to  this  last  point  that  we  can  hope 
to  give  permanent  relief. — Lond.  and  Edin.  Monthly  Journ.  Med.  Sci.  July  1842, 
from  Lond.  Med.  Gaz.  June  21,  1842. 

46.  On  the  Operation  of  Tracheotomy  in  Croup,  performed  at  the  Children's  HoS' 
pital,  and  on  its  results.  By  B.  A.  Becquerel,  M.  D. — During  the  year  1841, 
twenty  cases  of  true  croup  were  admitted  into  the  Children's  Hospital,  Paris. 
The  whole  of  these  patients  died;  nineteen  perished  shortly  after  the  attack,  and 
one  who  had  recovered  from  the  croup  died  in  two  months  afterwards  of  pulmo- 
nary tubercles.  Of  the  twenty  cases,  thirteen  were  boys  and  seven  girls;  the 
ages  of  the  patients  varied  from  two  to  fourteen  years. 

The  operation  of  tracheotomy  was  performed  in  nine  cases,  eight  times  by  the 
hospital  internes,  and  once  by  M.  Guersant,  jun.  In  the  following  remarks  I 
shall  endeavour  to  describe,  first,  the  circumstances  under  which  the  operation 
was  performed;  second,  its  immediate  results;  and  third,  its  remote  conse- 
quences. 

1.  Circumstances  under  which  the  operation  was  performed. — In  all  the  nine 
cases  the  children  were  in  the  most  dangerous  state,  and  no  other  hope  of  safety 
remained;  in  one,  indeed,  the  operation  was  performed  at  the  instant  the  little 
patient  expired,  and  with  the  faint  hope  of  restoring  it  to  life.  The  subject  of 
another  case  was  a  child  four  years  of  age,  who  had  been  ill  three  days;  the 
cough  and  voice  were  extinct,  and  asphyxia  was  imminent;  there  were  several 
traces  of  false  membranes  on  the  amygdale  and  pharynx.  The  child  was  carried 
to  the  hospital,  and  operated  on  without  delay.  The  symptoms  of  asphyxia, 
however,  were  much  aggravated  during  her  removal,  and  the  patient  expired 


1842.]  Surgery.  47& 

immediately  after  the  operation.  On  examination  a  cylinder  of  false  membrane 
was  found  adhering  to  the  larynx  and  two  upper  thirds  of  the  trachea.  Had  the 
operation  been  performed  half  an  hour  earlier,  and  the  false  membrane  been  ex- 
pelled, it  is  clear  that  the  operation  might  have  been  successful.  In  a  third  case, 
M.  Guersant,  Jan.,  operated  on  a  child  affected  with  siridulous  laryng-itis  which 
bore  a  perfect  resemblance  to  true  croup;  but  no  trace  of  false  membrane  escaped 
from  the  opening  or  was  found  after  death.  The  periods  at  which  tracheotomy 
was  performed  in  the  nine  cases  were  as  follows: — 1  on  the  second  day;  3  on  the 
third;  3  on  the  fourth;   1  on  the  fifth;  and  1  on  the  sixth  day. 

2.  Immediate  results  of  the  operation. — In  none  of  the  cases  did  any  blood 
penetrate  into  the  trachea,  in  sufficient  quantity  to  give  rise  to  or  increase  the 
asphyxia.     The  operation  was  easy  of  execution  and  quickly  performed. 

In  four  cases  the  operation  was  followed  by  syncope;  this  generally  lasted 
a  short  time,  but  in  one  case  it  was  so  prolonged  that  we  were  about  to  abandon 
the  child  as  dead;  one  of  the  assistants,  however,  kept  up  artificial  respiration 
for  ten  minutes,  and  the  child  was  restored  from  apparent  death. 

One  of  the  first  effects  of  the  operation  was  invariably  a  remarkable  improve- 
ment in  the  patient's  condition;  the  children  appeared  as  if  they  were  restored 
to  life;  the  respiration  became  slower  and  more  free,  and  the  purple  hue  of  the 
face  disappeared.  Occasionally,  however,  there  were  fits  of  coughing  at  this 
period,  either  coming  on  spontaneously  or  excited  by  the  canula,  and  a  quantity 
of  false  membrane  or  mucus  was  ejected.  In  several  cases  the  whole  of  the 
false  membranes  was  removed  after  the  operation;  they  did  not  form  again,  or 
in  very  small  quantities,  yet,  whenever  the  wound  was  closed,  suffocation  be- 
came imminent. 

3.  Remote  results  of  the  operation, — These  may  depend  on  the  single  or  com- 
bined influence  of  three  causes^viz.,  the  child's  sojourn  in  an  hospital,  the  per- 
sistence of  the  disease,  or  the  operation  itself. 

In  the  seven  cases  now  analysed  (two  are  omitted  because  they  proved  instan- 
taneously fatal),  the  interval  between  the  operation  and  the  death  of  the  patient 
was,  in  one  case,  7  hours;  in  one,  10  hours;  in  one,  29  hours;  in  one,  30  hours; 
in  one,  42  hours;  in  one,  7  days;  and  in  one,  10  days. 

The  following  are  the  unfavourable  symptoms  noticed  after  the  operation: — 

1.  Persistence  of  the  dyspnoea;  this  generally  occurred  in  paroxysms,  and  was 
accompanied  by  fits  of  low,  stifled  cough;  it  was  alleviated  by  the  expulsion  of 
mucus. 

2.  Secretion  of  a  great  quantity  of  mucus  or  muco-purulent  matter. 

In  three  cases  I  was  struck  by  the  enormous  quantity  of  mucus  secreted  by 
the  bronchi,  infinitely  greater  than  what  occurs  in  any  form  of  bronchitis 
amongst  children;  in  two  cases  no  trace  of  lesion  of  the  bronchial  mucous 
membrane  could  be  discovered.  The  existence  of  this  excessive  secretion  was 
indicated  by  a  mucous  rale  all  over  the  chest.  It  evidently  depended  on  the 
unusual  stimulus  of  cold  air  passing  in  through  the  trachea.  As  the  little  pa- 
tients began  to  sink  they  were  often  unable  to  expel  this  mucus;  and  by  drying 
in  the  canula  it  gave  rise  to  paroxysms  of  suffocation.  Great  care  must  be  taken 
to  keep  the  instrument  clear,  or  change  it  often;  or  to  excite  coughing  by  instill- 
ing a  few  drops  of  water  through  the  canula. 

3.  Inflammation  of  the  lining  membrane  of  the  air  passage  and  pneumonia 
are,  also,  complications  which  occur  both  after  the  operation  and  in  cases  where 
it  has  not  been  performed. 

4.  In  almost  every  case  the  operation  was  followed  by  intense  general  fever; 
and  in  two  cases  the  febrile  symptoms  ran  so  high  (although  no  inflammation 
of  the  lungs  could  be  discovered)  that  it  was  necessary  to  take  blood  from  the 
arm. 

5.  Convulsions  came  on  in  two  cases;  in  one  they  appeared  two  days  before 
death,  and  in  the  other  were  instantly  fatal. 

6.  In  one  case,  where  the  child  survived  to  the  tenth  day,  the  edges  of  the 
wound  became  gangrenous;  but  this  occurred  under  an  epidemic  influence,  and 


480  Progress  of  the  Medical  Sciences,  [Oct. 

without  it  the  little  patient  would  have  probably  recovered.     In  another  case 
there  was  emphysema  of  the  neck. 

7.  Post-mortem  appearances. — In  the  child  on  whom  M.  Guersant  operated, 
nothing-  was  found  after  death,  except  a  small  quantity  of  mucus  in  the  larynx 
and  trachea,  with  lobular  pneumonia  in  the  right  side  of  the  chest.  It  is  difficult 
to  say  whether  the  case  was  one  of  stridulous  laryngitis,  or  merely  a  nervous 
affection;  or  whether  the  false  membranes  were  expelled  without  being  noticed. 
The  child  died  nineteen  hours  after  the  operation.  In  three  of  the  six  remain- 
ing cases  there  were  false  membranes  in  the  pharynx;  in  one,  no  trace  of  false 
membrane  was  found  after  death,  but  they  had  been  removed  after  the  operation 
and  expelled  by  coughing.  In  one  case  no  lesion  whatever  was  found;  a  great 
quantity  of  mucus  had  been  ejected  during  life,  but  there  was  no  inflammation 
of  the  lungs  or  bronchi.  In  three  of  the  six  cases,  false  membranes  were  dis- 
covered in  the  bronchi,  but  no  trace  of  pus.  In  the  child  who  died  on  the 
second  day  there  was  intense  inflammation  of  the  trachea  and  bronchi.  Inflam- 
mation of  the  tissue  of  the  lungs  existed  in  four  cases. 

8.  Causes  of  death. — We  are  now  prepared  to  determine  the  causes  of  death 
after  tracheotomy  in  croup. 

These  are,  first,  bronchitis  or  an  excessive  secretion  of  mucus  in  the  bronchi; 
second,  pneumonia;  third,  the  persistence  of  the  original  disease,  and  especially 
the  presence  of  false  membranes  in  the  bronchial  tubes;  fourth,  convulsions; 
fifth,  finally  in  some  cases  death  occurs  without  our  being  able  to  detect  any 
local  disease,  and  it  seems  to  result  from  the  general  condition  of  the  patient. 
This  latter  mode  of  termination  should  not  be  lost  sight  of  when  we  are  called 
upon  to  weigh  the  chances  of  success  or  failure  of  tracheotomy. — Prov.  Med, 
Journ,,  Ap.  9,  184*2,  from  BuL  Gen.  de  Therap.Jan.  1842. 

47.  Statistics  of  Dislocations — From  an  examination  of  the  register  of  the  Hotel 
Dieu  of  Paris,  M.  Malgaigne  has  found  that,  during  a  period  of  sixteen  years, 
530  dislocations  were  admitted  into  that  institution,  of  which  there  was, 

between  45  and  50,  53 

"      50  and  55,  52 

"      55  and  60,  51 

"      60  and  65,  51 

"      65  and  70,  42 

"      70  and  75,  19 

"      75  and  80,  13 

"      80  and  90,  4 

90,  1 

Of  these  530  cases,  395  occurred  in  males,  and  135  in  females.  Of  491  cases 
in  which  the  seat  of  injury  was  particularised, 

321  w^ere  in  the  humerus,  34  were  in 

6  " 
2     " 

20     " 

7  " 
I     » 


below 

5  years  old, 

1 

between  5  and  10, 

4 

10  and  15, 

8 

15  and  20, 

29 

20  and  25, 

32 

25  and  30, 

40 

30  and  35, 

48 

35  and  40, 

38 

40  and  45, 

45 

33 

clavicle. 

26 

elbow. 

4 

radius. 

13 

wrist. 

17 

thumb. 

7 

fingers. 

he  femur, 
knee, 
patella, 
foot, 
jaw, 
spine. 


The  frequency  of  luxations  of  the  shoulder  in  elderly  persons  is  w^ell  shown 
by  the  fact,  that  of  164  dislocations  observed  in  patients  above  the  age  of  60, 
where  the  seat  of  injury  was  mentioned,  131  occurred  at  this  part. 

The  dislocations  of  the  clavicle  were  principall}''  confined  to  adult  life,  those 
of  the  elbow,  on  the  contrary,  were  mostly  in  young  persons;  one  third  of  all  the 
cases  observed  being  in  subjects  between  the  ages  of  10  and  20;  beyond  54  years, 
no  example  of  it  was  met  with. 

Of  the  34  dislocations  of  the  femur,  26  were  in  males  and  8  in  females. — 
Gaz.  Med.  Feb.  1841,  from  Jinn,  de  la  Chirurg. 


1842.]  Ophthalmology.  481 


OPHTHALMOLOGY. 

48.  On  a  peculiar  affection  of  the  Cornea  in  nurses.  By  Professor  Nasse. — A 
malignant  form  of  keratitis  or  inflammation  of  the  cornea  occasionally  accom- 
panies puerperal  attacks,  and  in  general  terminates  fatally.  This  affection, 
however,  is  not  of  a  malignant  nature,  and  appears  at  any  time  during  the  whole 
period  of  nursing,  from  a  month  after  delivery  to  a  year  and  a  half,  if  the  child 
be  suckled  so  long.  The  eye  is  felt  irritable  and  the  conjunctiva  is  seen  injected 
with  blood.  Occasionally  the  catarrhal  symptoms  attend  the  complaint,  at  other 
times  little  vesicles  appear  over  the  surface  of  the  conjunctiva.  Sometimes 
rheumatic  symptoms  are  present,  at  other  times  it  comes  on  with  a  vesicular 
cutaneous  eruption  over  the  face.  The  conjunctival  inflammation  rapidly  passes 
to  the  cornea  and  is  accompanied  by  the  usual  darting  pains  in  the  eye  and 
margin  of  the  orbit.  From  the  third  to  the  eighth  day  an  abscess  forms  within 
the  layers  of  the  cornea,  when  the  inflammatory  symptoms  diminish,  and,  if 
nothing  be  done  to  put  an  end  to  the  complaint,  it  bursts  into  the  anterior  chamber 
and  occasions  hypopion. 

The  disease  is  not  peculiar  to  any  age,  constitution,  or  season;  but  is  in  every 
case  preceded  by  great  lassitude,  debility,  and  leanness,  brought  on  by  excessive 
lactation,  in  fact,  seems  to  be  a  disease  of  debility.  Bloo;l-letting  is  conse- 
quently never  indicated,  but  blisters  behind  the  ears,  diaphoretics  combined  with 
bitter  infusions,  quinine  and  sulphuric  acid,  a  tonic  diet,  and  above  all,  the  giving 
up  suckling  the  child,  generally  effect  a  cure  in  about  three  weeks.  It  is  men- 
tioned that  the  separation  of  the  child  is  the  most  important  part  of  the  treatment; 
and  cases  are  related  where  the  child  being  allowed  to  suckle  before  the  cure 
was  completed,  brought  it  back  with  increased  severity,  and  could  not  be  stopped 
till  the  child  was  again  removed,  when  the  disease  rapidly  gave  w^y.—Edin. 
Med.  and  Surg.  Journ.  July,  1842,  from  Ammon's  Monatschrift  fur  Medicin, 
Nov.  1841. 

49.  Entropion. — Dr.  Jacob,  of  Dublin,  has  in  two  cases  successfully  treated 
entropion  by  the  following  operation,  which  is  a  modification  of  that  of  Sir  P. 
Crampton. 

"The  patient  being  placed  in  a  sitting  posture,  and  the  head  supported  by  an 
assistant,  the  inverted  upper  lid  was  separated  from  the  globe  of  the  eye  by 
means  of  the  finger  or  a  sharp  hook,  and  then  with  a  pair  of  strong  scissors 
two  perpendicular  incisions  were  made  through  the  tarsal  cartilage,  each  about 
a  quarter  of  an  inch  in  length,  one  upon  the  temporal,  the  other  upon  the  nasal 
side,  avoiding  the  punctum,  and  including  the  whole  inverted  portion  of  the  lid; 
this  part  being  now  everted  and  held  in  that  position,  the  two  perpendicular  in- 
cisions were  connected  by  a  horizontal  incision  upon  the  conjunctival  surface 
close  to  the  ciliary  margin  by  means  of  a  scalpel,  cutting  through  the  conjunc- 
tiva and  tarsal  cartilage,  and  leaving  the  inverted  portion  of  the  margin  united 
to  the  rest  of  the  lid,  merely  by  the  integuments;  taking  care  that  the  knife  did 
not  penetrate  through  the  skin.  The  inverted  portion  of  the  lid  now  no  longer 
turned  against  the  ball  of  the  eye,  and  as  soon  as  the  smarting  from  the  operation 
subsided,  the  patient  felt  relief— a  light  pledget  of  lint  wet  with  cold  water,  or  a 
dilute  solution  of  sulphate  of  zinc  was  then  laid;  upon  the  eye,  and  moistened 
occasionally. 

"The  success  of  this  operation  depends  in  a  great  measure  upon  the  edges  of 
the  incision  being  prevented  from  uniting  by  the  first  intention,  particularly  the 
horizontal  incision  upon  the  conjunctival  surface;  this  is  effected  by  everting  the 
lid  occasionally  during  the  first  few  days,  and  by  touching  the  edges  immediately 
after  the  operation  with  the  sulphate  of  copper,  so  as  to  cause  it  to  suppurate  and 
fill  up  by  granulation." — Dublin  Medical  Press,  27th  July,  1842. 

50.  Intermittent  Amaurosis. — Dr.  Stoeber  relates,  in  the  JInnales  d"* Oculisiique 
(Oct.  1841),  a  case  of  intermittent  amaurosis.     It  was  cured  by  quinine. 

No.  VHL— October,  1842.  41 


482  Progress  of  the  Medical  Sciences,  [Oct. 

51.  Hereditary  Ptosis. — Dr.  Alessi  has  recorded  in  an  Italian  Journal,  the  Fili- 
atre  Sebezio,  a  curious  case  of  hereditary  falling  down  of  the  upper  eyelid  in 
several  members  of  a  family  in  Sicily.  The  man,  who  first  applied  to  him,  was 
affected  with  an  incomplete  ptosis  of  the  left  upper  eyelid;  it  was  more  consi- 
derable at  the  outer  than  at  the  inner  canthus.  When  he  wished  to  look  at  an 
object  with  this  eye,  he  was  obliged  to  turn  his  head  round  over  his  right  shoul- 
der. On  being  questioned  how  this  malady  had  occurred,  he  told  Dr.  A.  that 
it  was  hereditary  in  his  family,  for  that  both  his  father  and  his  son  were  affected 
in  a  similar  manner. 

By  a  bizarre  singularity,  the  males  alone  were  affected;  and  what  makes  the 
occurrence  still  more  strange,  is  that  the  deformity  changed  sides  at  each  gene- 
ration. Thus  in  his  father's  case  it  was  the  right  eye  that  was  affected;  in 
himself,  it  was  in  the  left  one;  in  his  son  it  was  again  the  right;  and  in  his 
grandson  it  was  the  left.  Dr.  Alessi  satisfied  himself  of  the  truth  of  the  state- 
ment by  personally  examining  his  son  and  grandson.  He  (the  Dr.)  was  of 
opinion  that  the  falling  down  of  the  eyelid  was  owing,  not  to  any  paralysis  or 
atony  of  the  levater  muscle,  but  to  an  unusual  flatness  or  depression  of  the  supra- 
ciliary  arcade  of  the  frontal  bone,  so  that  the  integuments,  although  not  abnor- 
mally lengthened,  hung  down  in  front  of  the  eyeball.  Dr.  A.  proposed  an 
operation,  but  none  of  the  patients  would  submit  to  it. — Med.  Chirurg.  Rev.  from 
Encyolographie  des  Sciences  Medicates. 

52.  Wound  of  the  Orbit,-  Rupture  of  the  Optic  Nerve. — Mr.  Phillips  has  re- 
corded, in  the  London  Medical  Gazette  for  Jan.  1841,  a  curious  case  of  this  very 
rare  injury.  A  man,  standing  at  the  head  of  a  horse  which  had  fallen  in  the 
street,  was  suddenly  struck  in  the  face  upon  the  animal  rising  itself  up  unex- 
pectedly: the  blow  was  so  violent  that  he  was  thrown  down  by  it.  He  was  of 
opinion  himself  that  it  was  not  the  head  of  the  horse,  but  some  part  of  the  har- 
ness that  struck  him.  There  was  a  bleeding  wound  between  the  left  eye  and 
the  nose,  extending  for  about  three  quarters  of  an  inch  from  the  internal  canthus 
to  about  an  inch  below  the  eyebrow.  The  lachrymal  ducts  and  the  tendon  of 
the  orbicular  muscle  were  divided  across;  but  the  eyeball  had  not  suffered.  The 
sight  of  the  opposite  or  the  right  eye  was  lost  from  the  moment  of  the  acci- 
dent; and  yet  no  alteration  could  be  perceived  in  any  part  of  it,  except  extreme 
dilatation  of  the  pupil,  which  did  not  contract  even  upon  the  approach  of  a 
lighted  candle.  The  patient  complained  of  a  slight  headache,  but  nothing  indi- 
cated the  existence  of  any  lesion  within  the  cranium.  Delirium,  however,  and 
stupor  supervened  on  the  following  day;  and  as  these  symptoms  were  attributed 
to  the  invasion  of  meningitis,  the  patient  was  accordingly  bled,  purged,  and 
treated  with  repeated  doses  of  calomel  and  antimony.  In  the  evening  convul- 
sions came  on;  while  the  left  arm  and  leg  were  stiff  and  contracted,  the  right 
extremities  were  in  constant  motion;  the  pupil  of  the  right  eye  was  now  found 
to  be  contracted.  As  the  patient  could  no  longer  swallow  pills,  calomel  was 
applied  on  the  tongue;  a  blister  also  was  applied  to  the  nucha.  The  left  side  and 
extremities  became  subsequently  paralytic,  while  the  right  were  tranquil.  He 
died  convulsed  on  the  fifth  day  after  the  accident. 

Dissection. — There  was  a  marked  vascularity  also  and  a  copious  effusion  of 
lymph  between  the  arachnoid  membrane  and  the  pia  mater.  A  quantity  of  serum 
and  pus  was  found  in  the  lateral  ventricles.  Upon  lifting  up  the  anterior  lobes 
of  the  cerebrum,  they  were  observed  to  adhere  by  their  lower  surface  to  the  dura 
mater  in  consequence  of  effused  coagulable  lymph.  The  right  optic  nerve  was 
found  to  be  fairly  torn  across;  the  two  ruptured  ends  adhering  together  only  by 
a  thin  membrane,  close  to  the  optic  foramen.  The  base  of  the  brain,  from  the 
medulla  oblongata  to  the  commissure  of  the  optic  nerves,  was  invested  with  a 
thick  covering  of  plastic  lymph,  which  partly  concealed  the  roots  of  the  nerves. 
At  the  posterior  part  of  the  right  anterior  lobe,  and  near  to  the  seat  of  the  lace- 
rated nerve,  there  was  a  small  spot  where  the  cerebral  substance  was  in  anecchy- 
mosed  and  softened  state.  This  injury  of  the  encephalon,  as  well  as  the  lacera- 
tion of  the  nerve,  had  been  caused  by  a  spicula  or  fragment  of  bone,  detached 


1842.]  Ophthalmology,  483^ 

from  the  circumference  of  the  optic  foramen.  Upon  examining  the  orbitar 
wound  attentively,  there  was  found  a  small  aperture,  by  which  a  probe  could  be 
made  to  pass  through  the  breach  in  the  ethmoid  bone  into  the  cranium.  This 
showed  that  the  instrument,  which  the  horse's  head  had  driven  in  the  direction 
of  the  opposite  orbit,  had  been  pointed,  and  that  it  must  have  struck  with  force 
on  the  OS  planum^  passing  from  below  upwards  to  the  cerebral  lamina  of  the 
ethmoid  bone  of  the  opposite  side. 

Dr.  Rognetta  appends  the  following  observations  to  the  history  of  the  preced- 
ing case. 

*'  Although  there  are  several  analogous  cases  recorded  in  surgical  works,  the 
present  one  is  in  some  respects  almost  unique.  The  most  remarkable  circum- 
stance connected  with  it  is  the  direct  lesion  of  the  optic  nerve  of  the  side  opposite 
to  that  of  the  wounded  orbit.  We  know  that  the  optic  nerve  may  be  wounded 
directly  in  the  orbit  by  a  pointed  instrument  entering  by  its  external  canthus;  for, 
as  it  describes  a  curve  with  its  convexity  outwards,  it  is  readily  accessible  from 
this  part.  But,  before  the  case  related  by  Mr.  Phillips  was  made  known,  we  had 
never  heard  of  an  injury  of  the  intra-cranial  portion  of  one  optic  nerve  by  an 
instrument  which  had  entered  by  the  internal  canthus  on  the  other  side. 

"  It  is  worthy  of  notice  that  in  this,  and  in  other  somewhat  similar  cases  where 
the  optic  nerve  alone  has  been  injured,  the  ball  of  the  eye  usually  does  not  ex- 
hibit any  outward  marks  of  the  lesion;  the  only  symptom  present  being  amau- 
rotic blindness.  In  a  dissection  made  by  Cheselden,  and  in  another  by  Morgagni, 
the  optic  nerve  had  been  for  a  length  of  time  disorganised  from  spontaneous 
disease;  and  yet  the  eye  in  both  instances  retained  its  normal  features  in  every 
respect.  Do  not  such  facts  show  that  the  optic  is  purely  a  sensory  nerve,  and 
has  nothing  to  do  with  the  nutrition  ot  the  eyeball] 

*'  Dupuytren  used  to  mention  the  case  of  a  fencing-master,  who  met  with  his 
death  in  the  following  manner.  His  adversary's  foil,  though  guarded  with  a 
button,  pierced  through  the  wire  fence  of  his  mask,  and  struck  him  at  the  base 
of  the  right  upper  eyelid,  making  a  small  wound  there.  He  fell  down,  and  was 
carried  to  the  Hotel  Dieu.  On  the  morrow,  alarming  encephalic  symptoms,  de- 
lirium, convulsions,  coma  and  fever,  supervened,  and  he  died  two  days  after- 
wards. On  dissection,  the  orbitar  plate  of  the  frontal  bone  was  found  to  have 
been  pierced  by  the  point  of  the  foil,  which  had  penetrated  so  deep  as  to  wound 
the  anterior  lobe  of  the  brain.  Another  case,  very  similar  to  this  one,  occurred 
to  one  of  the  pupils  of  the  Polytechnic  School;  he  remained  hemiplegic. 

"The  same  sort  of  accident  has  been  known  to  be  caused  by  a  blow  with  the 
point  of  a  cane,  of  an  umbrella,  of  a  fork,  of  an  awl,  &c.  &c.  In  a  few  rare 
instances,  the  optic  nerve  has  been  lacerated  by  a  violent  luxation  of  the  eye- 
ball itself."— /62U 

53.  Belladonna  as  a  douche  in  some  forms  of  Ophthalmic  disease. — The  No.  of 
our  esteemed  cotemporary,  the  Provincial  Medical  Journal,  for  9th  April  last, 
contains  some  interesting  observations  on  the  use  of  belladonna  employed  as  a 
douche,  in  iritis  and  some  other  forms  of  ophthalmic  disease,  by  F.  A.  Bullet, 
Esq.,  of  Reading.  Mr.  BuUey  uses  different  ingredients  in  solution  as  a  douche, 
according  to  the  particular  structures  involved,  or  the  peculiar  form  of  disease 
which  presents.  In  a  case  of  incipient  iritis  and  atonic  ophthalmia,  he  made  use 
of  a  lotion  containing  belladonna,  with  a  small  quantity  of  sulphate  of  copper; 
but  he  used  it  a  very  short  time,  finding  the  symptoms  disappear  under  its  em- 
ployment, and  warm  water  alone  was  afterwards  sufficient  for  the  cure.  In  a 
case  of  more  confirmed  iritis,  he  persisted  in  the  belladonna  douche  during  the 
whole  period  of  the  treatment,  because  it  was  necessary  to  do  so  from  the 
intensity  of  the  disease,  and  the  adhesions  which  had  apparently  occurred.  In 
a  case  of  simple  conjunctival  inflammation,  with  lachrymal  abscess,  he  used 
warm  water  alone,  because  the  iris  being  unaffected,  it  was  not  necessary  to 
employ  the  belladonna.  He  has  used  other  remedies  in  solution,  more  par- 
ticularly the  wine  of  opium  with  sulphate  of  copper,  which  he  has  found  espe- 


484  Progress  of  the  Medical  Sciences.  [Oct. 

cially  useful  in  the  scrofulous  aifections  of  the  eyes  in  children  where  a  slightly 
stimulating  douche  is  required. 

The  manner  in  which  he  uses  the  douche  is  as  follows: — If  the  iris  be  the  seat 
of  disease,  and  the  conjunctiva  be  likewise  affected,  he  employs  the  following 
lotion; — 

B. — Extract  of  belladonna,  twenty  grains; 
Sulphate  of  copper,  five  grains; 
Water,  a  pint.     For  a  lotion. 

This  is  to  be  injected  frequently  during  the  day  with  a  clean  brass  syringe, 
with  an  ivory  pipe  capable  of  holding  from  three  to  four  ounces  of  the  fluid;  at 
first  it  is  necessary  to  throw  the  stream  upon  the  closed  lids,  at  least  for  the  few 
first  times.  By  degrees,  however,  the  patient  becomes  inured  to  the  shock,  and 
after  a  time  is  able  to  receive  the  continued  stream  upon  the  exposed  surface  of 
the  eye  without  experiencing  any  disagreeable  sensation.  The  most  marked 
improvement  will  be  found  to  follow  the  three  or  four  first  applications  of  the 
douche. 

Besides  the  intrinsic  value  of  the  douche  as  a  remedy  in  ophthalmic  disease,  it 
possesses,  Mr.  B.  thinks,  advantages  over  the  common  method  of  applying  lotions 
to  the  eye.  "It  is  impossible,  or  at  least  difficult,"  he  observes,  "by  any  other 
means,  to  remove  entirely  from  the  surface  of  the  eye  the  pus  which  is  secreted 
from  the  inflamed  membranes,  especially  as  some  slight  force  is  sometimes  ne- 
cessary to  detach  it,  and  I  have  often  found  that  the  simple  contact  of  fluid  in  an 
eye-glass,  which  is  the  most  common  method,  will  not  produce  its  removal.  The 
other  means  which  are  commonly  employed  to  convey  lotions  to  the  eye,  not 
unfrequently  increase  the  irritation  of  the  surface,  and  very  often  aggravate  the 
disease. 

"  With  regard  to  its  application  generally  in  diseases  of  the  eye,  I  was  led  to 
adopt  it  from  witnessing  the  excellent  effects  of  the  warm  douche  bath  when 
used  in  diseased  states  of  the  fibrous  tissue  of  the  joints,  and  I  thought  that,  as 
the  structures  were  somewhat  analogous,  something  like  the  same  results  might 
be  produced.  In  this  I  have  not  been  disappointed,  and,  as  I  have  found  the 
value  of  the  remedy  myself,  I  am  anxious  that  it  should  have  a  fair  trial,  not 
wishing  to  take  any  credit  for  my  suggestion  until  its  merits  have  been  more 
fully  ascertained,  and  I  shall  feel  obliged  to  any  one  who  will  give  it  a  fair  and 
impartial  trial. 

"Its  good  results,  in  most  of  the  cases  which  I  have  seen,  seem  to  be  due  to 
the  gently  stimulating  eflfects  which  the  warm  medicated  water,  applied  in  this 
way,  have  upon  the  minute  vessels  of  the  tissues  of  the  eye,  reducing  inflam- 
mation by  increasing  the  circulation  through  them  where  the  external  tunics 
only  are  concerned;  but  where  the  iris  is  either  primarily  or  secondarily  impli- 
cated, of  course  much  must  be  referred  to  the  specific  effect  of  the  belladonna  in 
allaying  the  increased  nervous  irritability  of  its  tissue,  upon  which  the  inflam- 
mation may  often  be  said  to  depend. 

"  There  is  a  particular  form  of  ulceration  of  the  cornea  in  which  I  have  found 
this  plan  of  treatment  particularly  useful. 

"In  ill  fed  and  anaemic  persons,  ulcers  will  frequently  appear  on  the  cornea, 
without  any  obvious  sign  of  inflammation  in  the  surrounding  vessels;  they  seem 
to  arise,  in  fact,  from  a  deficient  nutrition  of  its  texture.  It  has  been  proved  by 
microscopic  experiments,  and  it  is  now  generally  supposed  that  the  cornea  is  not 
vascular,  but  that  it  derives  its  nourishment  through  absorption  or  imbibition 
from  the  surrounding  vessels,  and  as  these  vessels  participate  in  the  general 
anaemic  condition  and  powerless  state  of  the  circulation,  of  course  the  cornea, 
which  is  dependent  on  these  for  its  supply,  in  some  measure  loses  its  vitality, 
and  destruction  of  its  texture  ensues.  In  these  cases  1  have  found  the  irrigating 
treatment  of  the  utmost  possible  service."* 

*  For  a  more  particular  description  of  this  condition — vide  Dr.  Williams's  Clinical 
Remarks. — "  Medical  Gazette." 


1842.]  Medical  Jurisprudence  and  Toxicology.  485 


MIDWIFERY. 

54.  Four  children  at  a  birth. — An  example  of  this  is  recorded  by  Dr.  Biggs 
in  the  Dublin  Med.  Press,  Jan.  5,  1842.  The  mother  was  only  six  months  preg- 
nant. All  four  children  were  males.  The  first  was  born  dead,  the  funis  pre- 
sented. The  second  and  third  were  born  alive,  but  the  former  lived  only  one, 
and  the  latter  only  two  hours.  The  fourth  was  born  dead.  Dr.  B.  extracted 
three  placentae, — two  united  together  and  one  separate.  He  says  nothing  of 
the  fourth  placenta. 

55.  Spontaneous  gangrene  of  the  Cervix  Uteri  and  part  of  the  Vagina. — M.  Baron 
communicated  to  the  Academy  of  Medicine  of  Paris,  22d  February,  a  case,  in 
which,  without  any  symptom  of  disease  of  the  genital  organs  except  leucorrhoea, 
hemorrhage  from  the  vagina  suddenly  came  on,  and  on  examination,  the  sepa- 
rated parts  were  found  lying  in  the  outlet.  They  presented  no  trace  of  disease, 
except  a  dark-coloured  line  at  the  point  of  separation,  marking  the  existence  of 
gangrene.     The  patient  recovered. 

56.  Occurrence  of  confluent  Smallpox  in  a  child  before  births  without  any  similar 
eruption  appearing  on  the  mother,  who  had  been  vaccinated.  By  Dr.  C.  Gnoli. — 
Rosa  Galvani,  37  years  old,  a  healthy  woman  who  had  been  vaccinated  success- 
fully when  an  infant,  was  delivered  of  a  male  child  on  June  3,  1841.  The 
labour  was  easy  and  the  mother  recovered  without  any  bad  symptoms,  but  the 
infant  was  an  eight  months'  child;  labour  seems  to  have  been  induced  by  the 
smallpox,  with  the  pustules  of  which  the  child  was  covered.  At  birth  the  child 
was  in  a  comatose  state,  from  which  it  was  relieved  by  allowing  some  blood  to 
flow  from  the  umbilical  cord.  On  the  second  day  the  pustules  appeared  at  their 
height,  on  the  fifth  day  maturation  began,  but  on  the  sixth  a  black  spot  showed 
itself  in  the  centre  of  each  pustule,  and  the  child  was  attacked  with  febrile 
symptoms,  subsultus,  and  trismus.  On  the  seventh  and  eighth  days  this  condi- 
tion became  aggravated,  and  the  child  died  at  3  A.  M.  of  the  ninth  day  after 
birth. 

When  interrogated  about  her  own  health,  the  mother  stated  that  about  a  week 
before  delivery  she  felt  generally  ill,  was  feverish,  lost  her  appetite,  and  suffered 
much  from  heat  in  the  stomach,  but  not  so  severe  as  to  make  her  seek  for  medical 
advice. — Brit,  and  For.  Med.  Rev.  from  Bull,  delle  Scienze  Med.  de  Bologna,  Aug. 
and  Sept.  1841. 


MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY. 

57.  Death  from  Lightning. — By  Professor  Carresi.  Read  at  the  Scientific 
Congress,  held  at  Turin  in  September  1840. 

Professor  Puccinotti,  in  his  Treatise  on  Legal  Medicine,  announces  a  sign  of 
death  from  lightning,  which  is  not  imitable  by  human  malice,  and  may  there- 
fore be  considered  as  pathognomonic. 

The  eyes  of  those  who  are  killed  by  lightning,  are  found  brilliant  and  pro- 
truding, so  that  the  eyelids  cannot  be  closed  over  them.  It  is  exactly  in  the  two 
lateral  segments  of  the  albuginea  thus  left  open,  that  the  sign  in  question  is 
observed,  and  which  may  be  considered  as  a  sanguineous  capillary  infiltration,  or 
an  electrical  burning.  It  consists  in  dark  bloody  spots,  of  a  conical  form,  and  much 
resembling  an  inverted  pterigium.  They  occupy  the  side  of  each  eye,  with  their 
basis  towards  the  iris  and  their  acute  angles  corresponding  to  the  internal  and 
external  angles  of  each  eye. 

This  mark  of  death  from  lightning,  is  usually  accompanied  with  an  injury  of 
the  epidermis  resembling  a  burn.     Small  portions  of  it  are  found  separated, 

41* 


48S  Progress  of  the  Medical  Sciences,  [Oct. 

and  rolled  up  and  crisp,  and  sometimes  wounds  of  an  oval  shape  are  noticed, 
passings  from  right  to  left  in  an  oblique  direction,  and  extending  into  the  sub- 
cutaneous cellular  tissue. 

Professor  Puccinotti  is  disposed  to  attach  equal  importance  to  both  of  these 
signs  as  characteristic  of  this  kind  of  violent  death.  Not  so,  however,  with 
Professor  Carresi.  In  three  cases,  seen  by  him  at  different  times,  the  dark 
bloody  spots  in  the  eyes  were  invariably  present,  but  the  injuries  to  the  epidermis 
of  the  wounds  were  wanting.  In  one  case  only,  there  was  on  the  back  of  the 
right  arm,  an  apparent  hardness  and  scorching  of  the  skin,  surrounded  by  an 
areola.  Its  size  was  about  an  inch,  and  its  shape  quadrangular. — Archives  de  la 
Mededne  Beige,  March,  1841.  T.  R.  B. 

58.  Unsuccessful  attempt  at  Suicide. — A  tailor  at  Bruges,  aged  &Q,  fired  a  pistol 
charged  with  two  balls  into  his  mouth.  He  fell  instantly,  but  was  immediately 
removed  to  the  office  of  the  Secretary  of  Hospitals.  When  there,  he  confessed 
his  intention  of  destroying  himself,  and  expressed  his  surprise  that  a  fatal 
effect  had  not  been  produced.  He  was  certain  that  he  had  charged  the  pistol 
properly,  having  been  for  years  in  the  cavalry  service,  and  could  only  account 
for  it,  by  supposing  that  the  balls  had  dropped  out  in  the  handling  the 
weapon. 

Drs.  Verte  and  De  La  Haye  were  soon  summoned  for  the  purpose  of  ascertain- 
ing as  well  his  mental  as  his  bodily  condition.  They  found  his  tongue  and  the 
roof  of  his  mouth  swollen,  so  as  to  render  articulation  almost  impossible,  but 
could  discover  no  wound  in  any  part. 

He  was  taken  into  the  hospital.  The  swelling  gradually  diminished  from 
day  to  day,  under  the  use  of  emollient  lotions.  On  the  fourth  day  after  admis- 
sion, one  of  the  attendants  showed  Dr.  Verte  a  ball,  which,  he  said,  had  come 
from  the  mouth  of  the  suicide.  Although  distrusting  the  truth  of  this,  yet  Dr. 
Verte  was  induced  to  examine  the  tongue,  and  he  found  a  small  wound  on  the 
third  posterior  middle  of  that  organ.  By  pressure  on  it,  he  felt  at  a  certain 
depth  a  hard  and  round  body.  The  case  was  mentioned  to  several  of  his  col- 
leagues, and  two  days  thereafter,  in  the  presence  of  a  number  of  them,  he  made 
an  incision  down  to  it,  and  removed  from  the  wound  a  pistol  ball  exactly  of  the 
same  size  as  the  one  that  had  been  already  discharged.  The  two  balls  together 
weighed  an  ounce,  they  were  still  round  and  not  flattened  on  any  part  of  their 
surface.    In  a  few  days  the  patient  was  perfectly  well. 

Dr.  Verte  observes,  that  the  Annals  of  Military  Surgery  are  filled  with  in- 
stances of  balls  glancing  the  part  struck,  and  being  found  at  extraordinary  dis- 
tances from  it.  Such,  however,  have  been  readily  accounted  for,  by  the  resistance 
encountered  in  infringing  on  a  bone,  an  aponeurosis,  or  a  tendon.  The  present, 
however,  resembles  none  of  these.  The  pistol  was  held  between  the  teeth,  and 
the  balls  entered  the  tongue,  in  which  they  were  found  at  less  than  an  inch  in 
depth.  He  inquires  whether  they  may  not  have  encountered  the  os  hyoides. 
This  being  a  movable  bone,  may  have  yielded  to  their  force,  instead  of  being 
perforated  by  them. 

Dr.  Meyer,  in  his  comments  on  this  case,  quotes  a  narrative  from  Van  Meeke- 
ren,  an  eminent  surgeon  of  the  seventeenth  century,  in  which  he  relates  the  extrac- 
tion of  a  ball  that  had  remained  for  near  six  years  in  the  tongue  of  a  Dutch 
soldier.— /6iU  November,  1841.  T.  R.  B. 

59.  Spontaneous  Ecchymosis  resembling  external  injury, — Dr.  Lados  mentions 
the  following  cases.  A  female,  five  months  advanced  in  pregnancy,  and  subject 
to  no  complaint,  except  occasional  severe  headache,  found  herself  one  morning 
on  awaking,  covered  with  dark  blue  spots,  precisely  similar  to  those  caused  by 
blows.  A  bleeding  and  some  laxative  medicines  were  sufficient  to  remove  these 
at  the  end  of  ten  days. 

In  another  instance  of  a  female,  six  months  advanced,  the  conjunctiva  of  the 
right  eye  became  suddenly  bloodshot,  and  two  irregular  ecchymoses  appeared  on 


1842.]  Medical  Jurisprudence  and  Toxicology,  487 

the  cheek  of  the  same  side.     The  patient  ascribed  their  occurrence  to  a  severe 
fright,  and  was  treated  successfully  in  the  same  way  as  the  former. 

If  such  cases  should  become  the  subject  of  medico-legal  inquiry,  how  are  we 
to  discriminate? — Ibid.  December,  1841.  T.  R.  B. 

60.  Poisoning  with  Verdigris. — ^Three  workmen  lately  died  at  Lyons,  from 
eating  at  a  tavern,  peas  boiled  in  a  copper  vessel.  M.  D'Arcet,  however,  men- 
tions a  curious  instance  of  exemption  from  any  injury,  in  the  case  of  a  number 
of  Cossacks  encamped  at  Paris,  in  1814.  Their  cooking  utensils  were  lined 
with  verdigris  and  yet  no  ill  effects  ensued.  He  ascribes  this  to  the  quantity  of 
bones  used, — supposing  that  they  neutralised  the  action  of  the  oxyde  of  copper. 
—Journal  de  Chimie  Medicale.  T.  R.  B. 

61.  Poisoning  by  the  liquor  of  Indigo  Blue. — This  substance  is  usually  pre- 
pared by  adding  sulphuric  acid  to  indigo,  and  a  portion  of  the  acid  is  probably 
more  or  less  in  a  free  state.  At  one  of  the  manufactories  in  France,  a  workman 
accused  of  a  robbery,  swallowed  from  700  to  800  grammes  (a  gramme  being 
twenty  grains)  of  the  above  liquid.  Repeated  vomitings  ensued,  and  the  matter 
thrown  up  produced  a  marked  effervescence.  His  mouth  and  clothes  were  stained 
of  a  blue  colour.  On  removal  to  the  hospital,  magnesia  diffused  in  milk  was 
copiously  given,  and  after  a  few  days  the  patient  was  discharged,  cured. 

As  several  cases  of  a  similar  nature  have  lately  occurred,  M.  Chevallier  pro- 
poses that  those  who  keep  the  article  in  question  for  sale,  should  be  required  to 
have  it  deprived  of  its  excess  of  acid. — Ibid.  T.  R.  B, 

63.  Instant  Death  from  a  Wound  of  the  Stomach. — Timothy  Daly,  a  policeman, 
in  attempting  the  arrest  of  a  robber,  was  shot  by  a  pistol  bullet.  He  almost  in- 
stantly expired. 

On  dissection,  a  wound  of  a  round  shape,  and  of  the  size  of  an  (English) 
sixpence,  was  found  between  the  seventh  and  eighth  ribs  of  the  left  side, 
and  another  on  the  right  side  over  the  last  rib.  The  lungs  and  heart  were 
healthy  and  uninjured.  The  blood  was  universally  fluid,  but  there  was  none 
extravasated  into  the  cavity  of  the  chest.  The  ribs  just  named,  were  each  found 
to  be  fractured.  The  stomach  was  removed  and  examined;  it  was  distended 
with  half  digested  food.  There  was  an  aperture  with  blackened  edges,  of  the 
size  of  a  shilling,  an  inch  below  the  junction  of  the  oesophagus  with  the  sto- 
mach on  its  posterior  surface,  and  another  corresponding  aperture  on  the  anterior 
surface  of  the  stomach,  also  at  the  cardiac  end,  but  lower  than  the  aperture  on 
the  posterior  surface.  The  liver  and  intestines  were  healthy  and  uninjured,  and 
no  important  blood-vessel  was  wounded. 

Mr.  R.  H.  Semple,  the  reporter  of  the  case,  imagines  that  instant  death 
"  must  have  been  caused  by  the  sudden  shock  given  to  the  nervous  system  by  the 
passage  of  the  bullet  through  the  distended  stomach.  No  other  cause  of  death 
(he  observes)  can  be  assigned,  for  no  other  viscus  was  wounded,  nor  was  any 
important  vessel  ruptured." — Lancet,  May  14,  1842.  T.  R.  B. 

63.  Dr.  Brett  on  detecting  minute  portions  of  Arsenic  and  Antimony. — The 
purity  of  the  sulphuric  acid  used,  was  ascertained  by  submitting  it  to  the  action 
of  sulphuretted  hydrogen.  Two  hundred  grains  of  zinc  were  next  operated 
upon,  by  means  of  an  apparatus  similar  to  Marsh's,  but  after  keeping  up  the 
flame  for  a  quarter  of  an  hour,  no  indications  of  arsenic  could  be  obtained  on 
white  porcelain. 

Considering  it  thus  established  that  the  tests  employed  were  pure.  Dr. 
Brett  next  made  some  experiments  on  zinc  and  arsenic.  Two  hundred  grains  of 
zinc  were  melted  in  a  crucible,  and  one  grain  of  metallic  arsenic  dropped  in  and 
stirred  about;  a  small  quantity  of  the  metal  was  volatilized;  the  alloy,  still 
fluid,  was  cast  on  a  clean  iron  plate,  and  when  cold,  introduced  into  the  hydro- 
gen apparatus  with  the  diluted  acid.  Very  large  and  abundant  arsenical  stains 
were  obtained.     One  quarter  of  a  grain  of  metallic  arsenic  was  next  added  to 


488  Progress  of  the  Medical  Sciences,  [Oct. 

two  hundred  grains  of  zinc,  and  melted.  The  alloy  obtained  as  above,  gave 
abundant  stains.  400  grains  of  zinc  were  melted,  and  0.4  of  a  grain  of  arsenic 
stirred  in.  This  alloy  was  cast  and  divided  into  eight  parts,  equal  by  weight. 
Three  of  these  gave  abundant  stains.  Two  of  the  above  eight  parts  were  again 
fused  with  400  grains  of  zinc,  and  the  product  divided  into  five  equal  parts. 
Two  of  the  last  produced  faint,  but  very  characteristic  arsenical  stains.  Here 
the  proportion  of  arsenic  was  one  part  to  5000  of  zinc.  This  appeared  to  be  the 
minimum  quantity  capable  of  being  detected  by  the  apparatus. 

The  next  experiments  were  for  the  purpose  of  ascertaining  the  minimum  quan- 
tity of  arsenic  that  could  be  detected.  2.24  grains  of  recently  sublimed  arse- 
nious  acid  were  dissolved  in  sixty  measures  of  water;  the  quantity  of  metallic 
arsenic  =1.69  gr.  Half  a  measure  of  this  solution  placed  in  the  apparatus  with 
zinc  and  sulphuric  acid  gave  several  strongly  marked  stains,  one-third  of  a 
measure  gave  several  faint  but  characteristic  stains,  and  one-sixth  only,  two  or 
three  very  faint  stains.  The  metal  in  this  last  was  .00469  of  a  grain,  or  rather 
less  than  gt/oths  of  a  grain.     This  was  the  minimum  quantity. 

Alloys  of  JLntimony  and  Zinc. — Two  hundred  grains  of  zinc  were  fused,  and 
one  grain  of  antimony  stirred  into  the  fused  mass.  The  alloy  when  cold,  gave 
large  and  abundant  antimonial  stains  with  the  apparatus.  So  also  did  200  grains 
of  zinc  to  which  .2  gr.  of  antimony  were  added.  Four  hundred  parts  of 
zinc  were  fused,  and  .4  grain  of  antimony  stirred  in;  the  allow  was  divided  into 
eight  parts;  one  of  these  was  again  fused  with  200  parts  of  zinc;  and  the 
alloy  thus  obtained  gave  abundant  and  characteristic  antimonial  stains.  The 
proportion  of  antimony  to  zinc  in  this  case  was,  as  1  to  5000.  On  continuing 
the  reduction,  the  minimum  quantity  of  this  alloy,  which  gave  a  very  few 
small,  but  characteristic  stains,  was  when  the  proportion  of  antimony  to  zinc 
was  as  1  to  13,000. 

On  proceeding  to  test  the  minimum  quantity  of  antimony  alone  to  be  thus 
ascertained.  Dr.  Brett  used  well  crystallised  tartar  emetic,  dissolving  it,  and 
then  placing  portions  of  the  solution  in  the  apparatus.  He  found  that  the  quan- 
tity of  the  metal  which  gave  very  small  stains,  and  only  two  or  three  in  number, 
was  =.00522  gr.,  and  he  therefore  considers  it  the  minimum  quantity. 

Appearances  of  the  stains — The  colour  of  the  flame,  when  antimony  is  present 
in  sufficient  quantity  to  produce  large  and  dark  stains,  does  not  differ  materially 
from  that  when  arsenic  is  present,  both  possessing  a  bluish  tint,  more  distinct, 
however,  in  the  case  of  arsenic;  very  small  quantities  of  arsenic  render  the  flame 
blue,  but  not  very  small  quantities  of  antimony.  The  mere  hydrogen  flame 
enlarges  more  when  arsenic  is  added,  and  there  is  a  greater  disengagement  of 
gas  bubbles.  In  both  cases,  when  minute  quantities  only  are  present,  it  takes 
a  considerable  time  to  make  the  metallic  stains  manifest  on  the  porcelain,  and 
the  deposition  will  in  such  instances  go  on  for  a  considerable  length  of  time. 
Dr.  Brett  has  collected  stains  for  a  quarter  of  an  hour  or  twenty  minutes. 

The  colour  of  the  arsenical  stain  is  generally  well  marked.  It  is  of  a  brown 
colour:  the  intensity  of  which,  as  well  as  that  of  its  metallic  lustre,  increases 
with  the  quantity.  The  antimonial  stains,  on  the  other  hand,  are  generally  of  a 
very  dark  colour,  almost  black  in  some  cases;  whenever,  indeed,  the  stains  are 
of  a  moderate  size,  they  never  assume  the  brown  colour  of  arsenic.  Still  it  must 
be  confessed,  that  when  the  quantity  of  arsenic  very  nearly  approaches  the 
minimum,  the  stains  do  begin  to  assume  a  brown  colour  in  some  cases,  closely 
resembling  arsenical  stains.  When  the  stains  are  of  a  compound  nature,  such 
as  may  be  obtained  from  the  mixed  gaseous  hydrurets  of  arsenic  and  antimony. 
Dr.  Brett  has  invariably  found,  unless  they  be  excessively  minute  and  attenu- 
ated, that  each  manifests  its  characteristic  colour;  the  brown  arsenical  stain 
appearing  around  the  dark  and  almost  black  antimonial  stain.  "  This  position  of 
the  arsenical  stain  is  due,  no  doubt,  to  its  greater  volatility,  for  in  collecting  pure 
arsenical  stains,  the  central  portions  are  almost  always  wanting  when  the  porce- 
lain is  held  in  such  a  manner  as  to  be  perpendicular  to  the  axis  of  the  flame: 
this  is  not  the  case  with  the  antimonial  stain  when  collected  under  precisely 


1842.]  Medical  Jurisprudence  and  Toxicology,  4S& 

similar  circumstances." — London,,  Edinburgh  and  Dublin  Philosophical  Maga- 
zine.  May,  1842.  T.  R.  B. 

64.  Signs  of  Maturity  in  new-born  Children. — According  to  Chaussier,  if  a  ma- 
ture child  be  measured  immediately  after  birth,  the  middle  of  its  length  will  be 
exactly  at  the  navel,  or  a  very  little  below.  It  is,  however,  doubtful  whether  this 
happens  in  all  cases;  and  Mende  has  impugned  its  general  accuracy.  The  fol- 
lowing are  some  results  noticed  by  Mr.  Taylor,  Lecturer  on  Medical  Jurispru- 
dence at  Guy's  Hospital,  and  Dr.  Geoghegan,  Professor  of  Med.  Jurisp.  in  the 
Royal  College  of  Surgeons  in  Ireland. 


Case. 

Whole  length. 

Attachment  of  the  Umbilical  Cord 

1. 

18^ 

a  quarter  of  an  inch  belov/ 

the  centre, 

2. 

20 

half  an  inch         "         " 

3. 

Hi 

half  an  inch  nearly       *' 

4. 

16^ 

half  an  inch                   " 

5. 

}9 

half  an  inch                   V 

6. 

17 

a  little  below 

7. 

18 

exactly  at  the  centre. 

8. 

17 

exactly  at  the  centre. 

9. 

,    201 

a  little  below. 

10. 

19i 

a  little  below. 

11- 

184 

exactly  at  the  centre. 

Guyh  Hospital  Reports, 

Apri 

il,  1842. 

^ 

T.  R.  B. 

65.  Poisoning  by  Sulphuric  Acid.  Detected  in  the  Urine, — Dr.  Scoffern,  Lec- 
turer on  Chemistry  at  the  Aldersgate  School  of  Medicine,  London,  was  called  to  a 
girl  who  had  poisoned  herself  with  sulphuric  acid.  Black  frothy  matter  issued 
from  the  mouth;  the  extremities  were  cold;  pulse  almost  imperceptible,  and  the 
breathing  laboured  and  irregular.  Her  cap,  and  some  other  articles  of  dress, 
were  stained  with  black  marks.  Whitening  mixed  with  milk  was  freely  given, 
and  she  rallied  under  its  use,  but  vomiting  followed  of  a  dark  grumous  matter, 
and  this  was  succeeded  by  all  the  symptoms  of  gastritis,  and  although  she  some- 
times appeared  to  be  improving,  yet  the  result  was  fatal.  Her  death  occurred 
on  the  afternoon  of  the  second  day,  and  for  some  hours  previous,  owing  proba- 
bly to  the  administration  of  a  few  drops  of  laudanum,  she  had  been  totally  free 
from  pain.     She  died  suddenly  and  without  a  struggle. 

On  dissection,  the  lips  were  found  excoriated  and  much  blackened;  the  oeso- 
phagus congested,  and  also  blackened;  the  cardiac  and  pyloric  orifices  of  the 
stomach  intensely  inflamed,  blackened  and  excoriated,  while  the  middle  portion 
of  the  stomach  was  not  so  much  affected;  the  duodenum  slightly  affected,  and 
the  remaining  parts  of  the  intestinal  tube  nearly  filled  with  flatus.  The  kidneys 
were  very  much  inflamed,  exerting  an  acid  reaction  on  litmus  paper.  Dr.  Scof- 
fern, as  a  matter  of  curiosity  analysed  a  minute  portion  of  the  cap,  and  found  the 
results  to  be  most  satisfactory.  Distilled  water  in  which  this  had  been  digested, 
copiously  precipitated  chloride  of  barium,  and  another  piece  of  cap  on  being  treated 
in  a  test  tube,  gave  off  an  abundance  of  sulphurous  acid  gas,  evidenced  by  the  blue 
colour  produced  on  transmitting  it  through  a  mixture  of  iodic  acid  and  starch. 
Finding  that  the  kidneys  on  being  cut  into,  afforded  a  fluid  which  reddened 
litmus  paper,  he  applied  the  same  test  (which  was  first  proposed  by  Devergie) 
to  it,  and  obtained  similar  results,  "  thus  demonstrating  its  great  value,  and  sup- 
plying an  interesting  fact  to  the  physioloo-ist." — London  Medical  Gazette,  May 
27,  1842.  "^  T.  R.  B. 

66.  Experiments  on  the  action  of  hydrated  peroxide  of  Iron  on  Arsenic.  By  M. 
GuiBERT. — Guibert  was  induced  to  make  these  experiments  in  consequence  of 
being  requested  to  examine  the  memoir  of  Dr.  Maclagan  of  Edinburgh  on  the 
same  subject.     This  author,  in  common  with  several  others,  asserts  that  ammo- 


490  Progress  of  the  Medical  Sciences,  [Oct; 

nia  is  far  preferable  to  potash  in  preparing  the  oxide.  M.  Guibert  wished  to 
ascertain  the  reason  of  this  preference. 

He  prepared  some  in  both  ways,  washing  the  precipitates  carefully  by  decan- 
tation,  until  the  water  gave  no  indication  of  alkalinity  or  of  the  presence  of  sul- 
phuric acid.  He  then  poured  off  all  the  water.  The  two  magmas  varied  con- 
siderably in  appearance.  That  with  potash  was  of  a  reddish  yellow  colour, 
but  little  consistent,  and  readily  separated  into  layers  of  various  degrees  of 
thickness.  That  with  ammonia  was  of  a  deep  reddish  brown,  gelatinous,  and 
of  an  uniform  and  permanent  consistency. 

One  hundred  parts  of  the  former  yielded  4.46  of  oxide  of  calcined  iron;  one 
hundred  parts  of  the  latter  4.14  of  the  same.  Berzelius  asserts  that  the  oxide 
will  retain  some  portion  of  the  alkali  used  in  spite  of  repeated  washing,  and 
Guibert  ascertained  the  truth  of  this,  by  experiment.  Heat  even  did  not  drive  off 
all  the  ammonia,  until  it  was  raised  to  commencing  redness.  Both  then  retained 
a  small,  but  notable  proportion  of  the  respective  alkalies. 

From  a  series  of  experiments,  it  appeared,  that  five  parts  of  the  humid  per- 
oxide, whether  prepared  with  potash  or  with  ammonia,  precipitated  completely 
one  part  of  arsenic  from  its  solution.  The  mixture  gave  no  stains  with  Marsh's 
apparatus.  When  only  four  parts  of  the  respective  oxides  were  employed,  that 
with  ammonia  was  equally  powerful,  but  that  with  potash  showed  many  arseni- 
cal stains.  Finally,  when  only  three  parts  of  the  ammoniacal  hydrate  were 
used,  the  spots  produced  were  such  as  to  prove  that  its  minimum  to  be  adminis- 
tered should  rather  be  four  parts,  than  three.  That  with  potash,  from  the  pre- 
ceding results  evidently  should  not  be  less  than  four  and  an  half  parts. 

It  must  be  recollected,  that  in  these  experiments,  out  of  the  body,  the  action 
of  the  peroxide  on  the  solution  of  arsenic  was  allowed  to  continue  from  twenty- 
four  to  thirty-six  hours,  before  the  mixture  was  submitted  to  Marsh's  appa- 
ratus.    Larger  proportions  of  the  antidote  are  advisable  in  cases  of  poisoning. 

M.  Guibert  next  experimented  on  the  peroxide  dried,  not  by  heat,  but  in  the 
open  air,  at  the  ordinary  temperature  on  a  filter.  The  hydrate  prepared  in  this 
way  with  potash,  lost  by  heat,  33.4  parts  of  water,  leaving  66.6  of  calcined 
oxide.     That  with  ammonia,  lost  37.93  of  water,  leaving  62.07. 

When  six  parts  of  the  dry  hydrate  were  mixed  with  one  part  of  arsenic  in 
solution,  and  the  liquor  after  standing  for  two  days  was  filtered,  and  then  sub- 
mitted to  Marsh's  apparatus,  each  gave  indications  of  the  presence  of  arsenic 
nearly  similar.  W'hen  seven  parts  were  employed,  there  were  still  some  traces 
of  arsenic  in  each,  but  when  the  proportion  was  ten  times,  none  was  present. 
With  eight  parts,  the  ammoniacal  presented  no  traces,  but  the  potash  exhibited 
several.  "Thus  even  in  the  dry  state,  the  ammoniacal  exhibits  a  slight  supe- 
riority over  the  others,  while  both  have  evidently  lost  one  half  their  power  (by- 
desiccation)  of  neutralizing  the  arsenic." 

Lastly,  as  to  the  subcarbonate  of  iron  as  an  antidote.  M.  Guibert  has  taken 
quantities  of  the  dry  precipitate,  of  this  substance,  representing  respectively 
seven,  ten,  fifteen,  twenty  and  twenty-four  parts  of  calcined  oxide  to  one  of  arse- 
nic. The  mixed  solutions,  after  standing  from  thirty-six  to  forty-eight  hours, 
were  filtered.  With  fifteen  parts  of  the  oxide,  stains  were  produced  for  a  short 
time;  with  twenty  parts,  only  two  small  stains  were  observed,  during  a  full 
period  of  combustion;  and  with  twenty-four  parts,  every  trace  of  arsenic  had 
disappeared.  These  experiments  show,  that  the  subcarbonate  of  iron,  as  ordi- 
narily prepared,  is  about  three  times  less  active  in  neutralising  arsenic  than  the 
dry  hydrate  of  iron  prepared  with  ammonia,  and  six  times  less  active,  than 
the  same  hydrate  in  the  moist  state.  M.  Guibert  concludes  with  recommending 
that  apothecaries  be  required  to  keep  on  hand  the  last  named  preparation  as  the 
most  active  agent  in  checking  the  effects  of  the  poison. — Bulletin  General  de 
Therapeutique,  December,  1841.  T.  R.  B. 

67.  Shall  an  accused  person  be  allowed  Medical  Counsel? — The  following  case  has 
some  interesting  features.  A  female  in  France  was  accused  of  poisoning^her 
husband  and  children.    The  bodies  were  disinterred  fifteen  days  after  death,  and 


1842. J  Medical  Jurisprudence  and  Toxicology,  491 

a  medico-legal  examination  was  ordered.  The  woman,  confined  in  prison,  sent 
for  Dr.  Alirol,  and  desired  him  to  attend  the  examination  on  her  behalf. 

Dr.  A.  communicated  this  wish  to  the  district  attorney  (procureur  de  Roi)  and 
was  refused,  on  the  ground,  that  the  examination  was  necessarily  a  secret  one, 
even  as  it  regards  the  accused.  The  editor  of  the  Gazette  des  Hopiiaux^  to  whom 
these  facts  are  communicated,  and  from  whom  Dr.  Alirol  asks  advice,  give  it  as 
their  opinion,  that  the  present  is  a  case,  in  which  a  chemist  on  the  part  of  the 
accused,  should  be  allowed  to  be  present,  and  to  witness  the  methods  pursued  for 
the  detection  of  the  supposed  poison.  If  this  be  refused,  the  difficulty  of  de- 
fending the  accused  is  greatly  increased,  as  the  medical  witness  for  her  will  only 
be  informed  of  such  facts  as  may  come  out  on  the  trial. 

The  same  rule,  they  insist,  should  apply  incases  where  a  dissection  is  neces- 
sary, with  the  understanding  that  the  medical  friend  of  the  accused  is  in  no 
way  to  impede  the  appointed  examiners,  or  to  interpose  obstacles  in  their  way. 

Finally,  it  is  suggested,  whether  the  ends  of  substantial  and  equal  justice 
would  not  best  be  promoted  in  every  case,  if  all  these  examinations  were  con- 
ducted by  individuals  nominated  both  by  the  accuser  and  accused.  Certainly 
much  of  the  discordance  in  opinion  that  now  constantly  occurs  between  medical 
witnesses  might  thus  be  avoided.  T.  R.  B. 

68.  Protracted  Gestation. — Earl  Spencer  has  noticed  that  cows  impregnated  by 
a  certain  bull  belonging  to  his  herd,  are  about/our  days  longer  before  they  calve, 
than  those  in  calf  to  other  bulls.  Thus  the  average  period  of  gestation  (as  de- 
duced by  him)  in  764  cows,  was  284  or  285  days,  but  in  75  cows  put  to  this 
bull,  the  average  period  was  2881  days.  Dr.  Hall,  in  stating  this  fact  on  the 
authority  of  Earl  Spencer,  suggests  the  possibility  that  the  male  of  the  human 
species  may  exert  a  similar  influence  on  the  duration  of  the  fcetus  in  utero! — 
London  Medical  Gazette,  May  6,  1842.  T.  R.  B. 

69.  Poisoning  of  the  East  India  Company''s  camels  in  Caubul,  by  Digitalis, — 
The  following  notice  is  taken  from  the  '*  Chemist"  for  August  1842,  in  which 
it  is  credited  to  the  £gra  Mchhar,  an  Indian  newspaper. 

"  Some  time  since  a  frightful  mortality  reigned  amongst  the  camels  belonging 
to  the  East  India  Company.  A  committee  was  appointed  to  investigate  the 
causes.  It  is  supposed  that  these  animals  were  poisoned  by  digitalis,  a  plant 
which  grows  abundantly  in  the  valley  of  Caubul.  The  natives,  it  is  said,  mali- 
ciously mixed  it  with  the  forage  intended  for  those  useful  animals. 

"  Montgiardini,  who  has  studied  the  effects  of  this  plant  on  animals,  says  that 
mammiferous  animals  are  very  sensible  to  its  action,  and  that  it  is  so  much  the 
more  dangerous  to  them,  as  their  stomach  more  resembles  that  of  man." 

T.  R.  B. 

70.  Verguin  on  the  Detection  of  Copper  in  Medico-legal  Analysis.  {Journal 
de  Pharmacie,  1841.) — M.  Verguin,  in  analysing  an  ore  of  copper,  placed  the 
solution,  by  chance,  in  a  platina  capsule,  and  wishing  to  reduce  the  metal,  intro- 
duced a  plate  of  iron.  No  effect  was  observed  on  the  iron  when  not  in  contact 
with  the  platina,  but  the  instant  it  touched  any  part  of  the  capsule,  the  platina 
was  covered  with  a  coat  of  copper,  which  adhered  so  firmly,  that  it  was  neces- 
sary to  use  nitric  acid  in  order  to  remove  it.  There  was  no  precipitation  on  the 
iron.  M.  Verguin,  in  consequence,  advises  the  following  process  in  medico- 
legal experiments. 

If  the  solution  to  be  examined  is  very  weak,  acidulate  it  with  a  little  muriatic 
acid.  Pour  a  drop  on  a  plate  of  platina,  and  then  apply  a  clean  plate  of  iron,  so 
that  the  iron  may  touch  at  once  the  liquid  and  the  platina.  At  the  end  of  a  few 
seconds,  the  whole  of  the  platina  that  has  been  covered  by  the  liquid,  will  be 
coated  with  a  layer  of  copper.  This  result  is  altogether  dependent  on  electro- 
chemical principles. 

The  tests  most  esteemed  for  the  detection  of  copper  are: — 1.  Ammonia.  But 
this  may  fail  in  giving  its  characteristic  blue,  if  the  liquor  contains  a  salt  that 


492  Progress  of  the  Medical  Sciences,  [Oct. 

can  be  precipitated  by  the  reagent,  and  again  it  may  not  succeed,  if  organic  sub- 
stances be  present.  2.  The  yellow  cyanuret  of  potassium.  This  is  a  minute 
test,  but  if  iron  be  present  in  the  suspected  liquor,  the  characteristic  brown  of 
the  salt  of  copper  will  be  lost  in  the  blue  colour  of  the  salt  of  iron.  3.  A  plate 
of  clean  iron.  This  frequently  fails  if  the  solution  be  weak,  and  if  an  acid  be 
added  to  quicken  its  action,  the  iron  often  darkens,  and  we  are  prevented  from 
distinguishing  the  cupreous  deposit.  Under  such  circumstances,  indeed,  it  is 
very  slightly  adherent,  and  is  lost  among  the  fluid. 

With  these  objections  to  the  tests  in  ordinary  use,  the  simplicity  and  certainty 
of  M.  Verguin's  render  it  highly  valuable.  T.  R.  B.  - 

71.  ErgoU — The  Paris  Society  of  Pharmacy  offered  a  prize  of  1000  francs, 
some  time  since^  to  the  person  who  should  ascertain  in  the  most  satisfactory 
manner,  the  active  principle  of  ergot.  A  single  essay  only  was  tendered,  vi'rit- 
ten,  as  was  afterwards  ascertained,  by  M.  Bonjean,  jun.,  of  Chambery.  The 
examiners  (of  whom,  Felix  Boudet  prepared  the  report)  do  justice  to  the  inves- 
tigations of  Wiggers  of  Berlin,  and  Wright  of  Edinburgh.  The  latter,  as  the 
result  of  his  elaborate  experiments,  inferred  that  the  oil  of  ergot  contained  all 
the  active  principles  of  the  substance. 

M.  Bonjean,  after  a  series  of  chemical  inquiries,  has  not,  according  to  the 
opinion  of  his  judges,  advanced  our  knowledge,  beyond  that  afforded  by  his 
immediate  predecessors.  Leaving  the  domain  of  chemistry,  he  proceeds  next 
to  that  of  physiology,  and  being  impressed  with  the  fact,  that  many  modern 
physicians,  after  using  various  preparations  of  ergot,  had  returned  to  the  powder 
itself,  as  the  most  certain  and  useful,  he  proceeded  to  ascertain  its  powers  by 
experiments  on  animals.  The  effect  on  dogs,  unless  they  rejected  the  ergot  by 
vomiting,  was  stupor  and  immobility.  In  cocks,  the  comb  and  crop  withered 
down  rapidly,  taking  on  a  violet,  and  in  some  instances,  a  black  colour.  This 
was  succeeded  by  a  species  of  intoxication  and  stupor,  which  terminated  in  death. 
Hares  perished  with  analogous  symptoms.  In  all  these,  the  quantity  sufficient 
to  destroy  w^as  from  10  to  15  grammes  (200  to  300  grains)  for  the  weakest,  and 
30  for  the  largest.  Death  generally  ensued  at  the  end  of  forty-eight  hours. 
On  dissection,  all  the  organs  were  found  healthy,  except  that  the  brain  and  its 
coverings  were  uniformly  more  injected  than  is  natural.  Our  author,  from  all 
these  results,  classes  ergot  among  the  narcotic  poisons. 

From  a  single  experiment,  it  would  seem  that  the  panary  fermentation  has 
the  power  of  destroying  the  venomous  properties  of  ergot;  but  this,  to  use  the 
language  of  the  reporter,  requires  much  additional  confirmation,  before  we  can 
discredit  the  numerous  accidents  ascribed  to  its  mixture  with  food,  in  former 
times. 

M.  Bonjean  next  proceeded  to  trials  with  the  various  products  obtained  from 
ergot.  A  dose  of  the  ergotine  of  Wiggers,  equivalent  to  125  grammes  of  ergot 
(2500  grains)  produced  nothing  beyond  an  acrid  feeling  in  the  throat;  while  the 
aqueous  and  the  alcoholic  extracts  of  ergot,  and  the  resinous  matter  that  it 
yields  to  sulphuric  ether,  were  all  innocuous  to  animals.  The  oil  of  ergot ^  how- 
ever, when  given  in  doses  representing  in  quantity  the  ergot  used  in  former 
experiments,  induced  similar  poisonous  results,  and  the  appearances  found  in 
animals  thus  poisoned,  on  dissection,  were  precisely  like  to  those  w^hich  we 
have  already  stated. 

The  author  supposes  the  deleterious  property  not  to  reside  in  the  oil  itself, 
but  in  a  special  prmciple  held  in  solution  by  the  oil,  and  which  is  very  readily 
altered  in  its  character,  and  loses  its  power  under  a  prolonged  heat  of  from  80° 
to  100°.  The  extract  of  ergot,  prepared  with  cold  water,  by  the  process  of  dis- 
placement, has  been  found  in  some  cases  efficacious  in  doses  of  from  one  to  two 
grammes  during  the  twenty-four  hours,  to  check  uterine  hemorrhages.  Its  vir- 
tues, however,  are  not  as  yet  perfectly  established. 

The  sum  of  three  hundred  francs  was  unanimously  awarded  to  M.  Bonjean 
for  his  essay.     (We  give  the  above  from  the  Ency  do  graphic  des  Sciences  Medi- 


1842.]  Medical  Jurisprudence  and  Toxicology,  493 

caks,  as  it  is  more  full  and  exact  than  the  brief  notice  at  page  222  of  the  present 
volume.)  T.  R.  B. 

72.  On  the  Action  of  Water  on  Lead.  By  Prof.  Christison. — In  a  second 
paper  on  this  subject,  just  published  in  the  Transactions  of  the  Royal  Society  of 
Edinburgh^  Vol.  15,)  Dr.  Christison  states  the  following  as  the  results  of  his 
entire  investigations. 

"  From  the  facts  now  detailed,  together  with  the  results  of  my  former  in- 
quiries, the  following  conclusions  may  be  drawn  as  to  the  employment  of  lead 
pipes  for  conducting  water.  1.  Lead  pipes  ought  not  to  be  used  for  the  purpose, 
at  least  where  the  distance  is  considerable,  without  a  careful  chemical  examina- 
tion of  the  water  to  be  transmitted.  2.  The  risk  of  a  dangerous  impregnation 
of  lead  is  greatest  in  the  instance  of  the  purest  water.  3.  Water  which  tar- 
nishes polished  lead  when  left  at  rest  upon  it  for  a  few  hours,  cannot  be  safely 
transmitted  through  lead  pipes  without  certain  precautions.  (Conversely,  it  is 
probable,  though  not  proved,  that  if  polished  lead  remain  untarnished,  or  nearly 
so,  for  twenty-four  hours  in  a  glass  of  water,  the  water  may  be  safely  conducted 
through  lead  pipes.)  4.  Water  which  contains  less  than  about  an  SOOOih  of 
salts  in  solution,  cannot  be  safely  conducted  in  lead  pipes  without  certain  pre- 
cautions. 5.  Even  this  proportion  will  prove  insufficient  to  prevent  corrosion, 
unless  a  considerable  part  of  the  saline  matter  consist  of  carbonates  and 
sulphates,  especially  the  former.  6.  So  large  a  proportion  as  a  4000th,  pro- 
bably even  a  considerably  larger  proportion,  will  be  insufficient,  if  the  salts  be 
in  a  great  measure  muriates.  7.  It  is,  I  conceive,  right  to  add,  that  in  all  cases, 
even  though  the  composition  of  the  water  seems  to  bring  it  within  the  condi- 
tions of  safety  now  stated,  an  attentive  examination  should  be  made  of  the 
water,  after  it  has  been  running  for  a  few  days  through  the  pipes.  For  it  is  not 
improbable  that  other  circumstances,  besides  those  hitherto  ascertained,  may 
regulate  the  preventive  influence  of  the  neutral  salts.  8.  When  the  water  is 
judged  of  a  kind  which  is  likely  to  attack  lead  pipes,  or  when  it  actually 
flows  through  them,  impregnated  with  lead,  a  remedy  may  be  found  either  in 
leaving  the  pipes  full  of  the  water,  and  at  rest  for  three  or  four  months,  or  by 
substituting  for  the  water  a  weak  solution  of  phosphate  of  soda  in  the  propor- 
tion of  about  a  25,000th  part. — London^  Edinburgh  and  Dublin  Philosophical 
Magazine^  August,  1842.  T.  R.  B. 

73.  Feigned  Diseases— Bloody  Urine. — There  are  certain  substances  which, 
when  taken  as  food,  invariably  impart  a  bloody  colour  to  the  urine.  One  of  these 
is  the  prickly  pear  or  Indian  fig  {Cactus  opuntia).  When  the  Spaniards  first  took 
possession  of  America,  many  of  them  were  alarmed  by  observing  that  they  passed 
what  they  supposed  to  be  bloody  urine,  but  it  was  soon  discovered  that  the  red 
colour  of  the  secretion  was  owing  to  the  liberal  use  they  made  of  that  fruit.  Dr. 
Hennen,  in  his  Military  Surgery,  quotes  a  similar  example  from  Ellicot's  Travels 
for  determining  the  boundary  of  the  United  States.  He  says,  "  his  people  ate  very 
plentifully  of  this  substance  at  an  island  of  the  Mississippi,  and  were  not  a  little 
surprised  the  next  morning  at  finding  their  urine  appear  as  if  it  had  been  highly 
tinged  with  cochineal.     No  inconvenience  resulted  from  it." 

Another  vegetable  substance,  with  which  we  are  more  familiar,  and  which 
will  produce  the  same  effect,  is  beetroot.  Desault  relates  the  case  of  a  person 
who  noticed  that  he  every  morning  voided  urine  of  a  deep  red  colour,  exactly 
such  as  would  result  from  adding  fresh  blood  to  that  liquid,  except  that  no  deposit 
took  place.  The  man  became  frightened  and  consulted  M.  Roux,  who,  after 
some  examination,  began  to  suspect  that  the  colour  was  owing  to  something 
else  than  the  admixture  of  blood.  It  turned  out  that  his  patient  was  in  the 
habit  of  supping  every  night  upon  the  red  beet  root,  and  as  soon  as  he  relin- 
quished this  as  an  article  of  diet,  the  supposed  bloody  urine  was  wanting. — 
Dr.  Watson's  Lectures.     London  Medical  Gazette^  July  8,  1842.  T.  R.  B. 

No.  Vlll.— October,  1842.  425 


494  Progress  of  the  Medical  Sciences,  [Oct, 

74.  Compound  poisoning  ivith  Arsenic  and  Opium, — I  have  noticed  two  cases  of 
this  description  in  my  work  on  Medical  Jurisprudence,  One  is  by  Mr.  Scott, 
(^Medico-Chirurgical  Beview,  vol,  ii.  p.  170,)  in  which  a  female  took  "fifteen 
pennyworth  of  laudanum  and  half  a  teacupful  of  arsenic,"  of  which  she  died  ia 
six  hours.  The  symptoms  are  not  stated,  except  that  she  suffered  great  torture. 
She  had  vomited  and  purged.  On  dissection,  two  masses  of  powdered  arsenic 
were  found  in  the  stomach. 

The  other  is  by  Mr.  Jennings,  {Edin.  Med.  and  Surg.  Journ.  vol.  .35,  p.  453.) 
Here  two  drachms  of  arsenic  and  three  ounces  of  laudanum  were  swallowed  at 
the  same  time.  When  first  seen  by  Mr.  Jennings  four  hours  after,  there  was 
no  pain  or  burning  in  the  throat,  stomach  or  bowels,  no  tenderness  of  the  abdo- 
men and  no  particular  stupor.  She  complained  only  of  being  tired  and  sleepy. 
The  pulse  was  100.  Drowsiness  increased;  and  although  she  once  or  twice 
complained  of  pain  in  the  bowels,  she  soon  became  comatose,  and  in  about  eight 
hours  after  taking  the  poison,  she  expired  in  a  state  of  profound  coma,  with 
dilated  pupils  and  laborious  breathing. 

Although  the  peculiar  symptoms  from  arsenic  were  thus  absent,  yet  the  fluid 
in  the  stomach  readily  gave  indications  of  its  presence,  with  the  sulphuretted 
hydrogen  and  nitrate  of  silver  tests. 

These  cases  have  their  interest  increased  by  the  following  experiment  made 
by  Lassaigne,  {Journal  de  Chimie  Medicale,  April,  1841.)  He  injected,  through 
an  incision  in  the  oesophagus,  into  the  stomach  of  a  stout  dog,  ten  grains  of 
arsenic  in  solution  and  all  the  soluble  parts  of  three  drachms  of  opium.  A  liga- 
ture was  placed  on  the  penis,  to  prevent  the  excretion  of  urine.  Shortly  after, 
the  animal  appeared  to  experience  nausea  and  foamed  at  the  mouth,  but  in  a 
quarter  of  an  hour  he  was  quiet.  The  effects  of  narcotism  increased,  and  in 
three  hours  he  was  dead. 

Dissection  was  immediately  practised.  The  liver  and  heart  were  removed, 
and  all  the  blood  as  well  as  urine  were  collected  for  examination.  Portions  of 
each  of  these  were  then  tested  for  arsenic,  but  without  success.  Traces  of  it 
were  indeed  discovered,  but  not  sufficiently  decisive  to  warrant  the  assertion  of 
its  presence. 

Attempts  were  next  made  to  ascertain  the  presence  of  opium.  A  portion  of 
the  urine  evaporated  down  was  tested  with  salts  of  the  peroxide  of  iron  and  with 
nitric  acid,  but  no  indications  either  of  meconic  acid  or  of  morphine  were  mani- 
fested. The  blood  was  next  examined  and  then  a  portion  of  the  liver,  but  with 
equal  ill  success. 

The  deductions  of  Lassaigne  from  this  case  are  as  follows: — 1.  Opium  mixed 
with  arsenious  acid,  acts  on  the  stomach  so  as  to  prevent  the  rapid  absorption 
of  the  mineral  poison.  2.  Although  death  in  this  instance  undoubtedly  ensued 
from  the  combined  action  of  the  two  poisons,  yet  traces  of  their  presence  cannot 
chemically  be  detected  in  the  viscera  or  fluids.  T.  R.  B. 

75.  Msorpiion  of  various  Mineral  Poisons. — At  a  meeting  of  the  Royal  Aca- 
demy of  Medicine,  of  Paris,  held  April  26,  1842,  the  following  communication 
was  received  from  M.  Orfila. 

Mr.  President: — I  beg  you  to  inform  the  Academy,  that  1  have  obtained  the 
following  results  from  a  great  number  of  experiments,  the  details  of  which  will 
be  immediately  published.  1.  That  the  sulphuric,  nitric,  muriatic  and  oxalic 
acids,  when  diluted  are  absorbed,  and  that  they  can  be  detected  in  the  urine. 
2.  That  the  same  acids  in  their  most  concentrated  form  are  also  absorbed,  as 
they  attract  not  only  the  fluids  of  exhalation,  but  also  those  in  the  digestive 
canal.  3.  That  the  absorption  of  the  salts  of  lead,  bismuth,  tin,  zinc,  gold  and 
silver,  is  unexceptionable;  since  these  metals  are  found  in  the  liver  and  in  the 
urine  of  dogs  poisoned  by  any  of  these  substances.  All  these  metals  may  be 
readily  extracted  by  one  and  the  same  process,  viz.,  carbonization  of  the  viscera 
by  nitric  acid,  and  then  treating  the  resulting  carbon  with  aqua  regia  or  nitric 
acid.  4.  That  the  salts  of  mercury  are  also  absorbed  in  part  by  the  blood  in  all 
the  organs;  and  in  order  to  prove  this,  it  is  only  necessary  to  dissolve  in  aqua 


1842.]  Medical  Jurisprudence  and  Toxicology,  495 

regia,  the  viscera  of  an  animal  thus  poisoned,  and  then  pass  through  the  solution 
a  stream  of  gaseous  chlorine,  or  what  is  still  better,  to  carbonize  the^^e  viscera 
with  a  strong  acid  in  close  vessels,  and  then  treat  the  carbon  with  boiling  aqua 
regia.  5.  That  I  have  also  found  in  the  viscera,  particularly  the  liver,  and  also 
in  the  urine,  indications  of  iodine,  of  liver  of  sulphur,  of  acetate  of  potash,  of 
alum,  of  ammonnia,  of  sal-ammoniao,  and  eau  de  javelle  (chloride  of  potash), 
with  each  of  which  I  have  poisoned  animals  in  the  course  of  my  experiments. — 
Bulletin  de  V Academie  Royale  de  Medecine,  May,  1842.  T.  R.  B. 

76.  Corpora  Luiea. — Dr.  Wm.  Davidson  of  Edinburgh,  gives  an  account  of  three 
dissections  of  females,  neither  of  whom  was  pregnant,  and  in  each  of  which,  cor- 
pora lutea  were  found.  They  had  all  the  characters  assigned  to  them  by  Dr.  Mont- 
gomery; a  central  cavity  or  fibrous  coagulum;  an  oval  form,  and  a  radiated  white 
cicatrix  in  the  centre,  just  about  the  central  body;  the  body  being  at  the  same  time 
immediately  under  the  peritoneal  coat.  This  last  is  much  insisted  upon  by  Robert 
Lee,  as  he  avers  that  "/a/se  corpora  lutea  are  never  observed  in  immediate  con- 
nection with  the  peritoneum,  a  small  portion  of  stroma  intervening."  As  to  the 
females,  the  first  had  been  in  a  weakly  state  for  some  years,  during  which  time 
she  had  no  children.  The  second  was  unmarried,  and  had  menstruated  three 
days  previous  to  her  death.  There  was  no  history  of  the  third  case,  but  all  the 
organs  were  healthy  and  the  fallopian  tube  and  uterus  were  in  every  way  natural. 
Dr.  Davidson  expresses  his  confident  opinion,  that  in  none  of  these  cases  had 
there  been  impregnation  previous  to  the  appearance  of  these  bodies.  He  refers 
to  Professors  Alison,  Allen  Thomson,  John  Reid,  and  Mr.  Goodsir,  in  proof  of 
the  correctness  of  his  statement,  and  of  their  perfect  resemblance  to  a  true  cor- 
pus luteum. 

Dr.  Davidson,  as  the  result  of  his  investigations,  says,  "T  am  led  to  believe, 
that  impregnation  cannot  take  place  without  the  appearance  of  a  true  corpus  luteum^ 
but  that  a  true  corpus  luteum  may  appear  independent  of  impregnation,^^ — Lond.  ^ 
Edin.  Month.  Med.  Journ.  Dec.  1841.  T.  R.  B. 

77.  Superfoetation. — Dumas,  an  attache  of  the  Faculty  of  Medicine  at  Mont- 
pelier,  has  discovered  a  case  related  by  Dionis,  which  bears  strikingly  on  this 
subject.  A  female  aged  twenty,  and  pregnant  about  two  months,  doubted  the 
existence  of  this  in  consequence  of  the  menses  continuing  as  usual.  The  symp- 
toms, however,  became  more  and  more  manifest;  and  at  four  months  and  a  half 
she  felt  the  motions  of  the  foetus;  at  the  fifth  month  the  menses  ceased,  and  vi^ere 
succeeded  by  a  slight  serous  discharge.  While  thus  advancing,  she  was  sud- 
denly seized  with  violent  pains  as  of  a  person  in  labour,  which  yielded  to  no 
remedy,  and  she  died  at  the  end  of  twelve  days. 

On  dissection,  a  foetus  was  found  in  the  abdominal  cavity,  and  the  uterus 
sufficiently  large  to  have  contained  it,  was  seen  ruptured  throughout  a  large  por- 
tion of  its  surface.  Towards  the  right,  was  another  lobe  connected  with  the 
ruptured  portion  by  a  single  neck,  but  smaller,  and  ia  the  interior  of  this  a  mole 
was  discovered. 

Here  was  a  case  of  bilobed  uterus,  in  one  of  whose  lobes,  pregnancy  was 
going  on,  while  menstruation  had  during  the  same  period,  occurred  in  the  other. 

The  above  is  contained  in  an  elaborate  memoir  on  Bilobed  and  Double  Uteri, 
published  in  the  Journal  of  the  Society  of  Practical  Medicine,  of  Montpelier. 
The  conclusions  of  M.  Dumas  from  a  consideration  of  these  cases  have  been 
already  given  (p.  447).  T.  R.  B. 

78.  Connection  of  precipitate  Labour  with  Mania. — "The  subject  of  preci- 
pitate labour  involves  a  medico-legal  question  of  great  importance  and  interest, 
which  has  as  yet  excited  little  or  no  notice  in  this  country,  viz.,  as  regards  acts 
of  child  murder  after  labours  of  this  character.  The  state  of  mental  excitement 
and  frenzy  into  which  a  patient  is  brought  by  a  labour  of  such  violence  and  suf- 
fering, in  many  cases  falls  little  short  of  actual  mania.  We  now  and  then  meet 
with  instances,  where  for  the  first  half  hour  or  so,  after  a  severe  and  rapid  labour, 


496  Progress  of  the  Medical  Sciences,  [Oct. 

the  patient  takes  a  most  insurmountable  antipathy  to  her  child,  and  expresses 
herself  towards  it  in  so  unnatural  a  manner,  as  to  contrast  strangely  with  the 
tender  and  affectionate  feelings  which  she  had  a  short  time  previously  expressed 
for  it.  Cases  have  occurred  where  the  patient  has  been  without  assistance 
during  labour,  and  where  in  a  state  of  temporary  madness  from  mental  excite- 
ment and  pain  at  the  moment  of  the  child's  birth,  she  has  committed  an  act  of 
violence  upon  it  which  has  proved  fatal;  a  circumstance  which,  from  obvious 
reasons,  would  be  more  liable  to  occur  with  single  than  with  married  women. 
These  cases  have  been  very  carefully  investigated  in  Germany  of  late,  and  in 
many  of  them  the  patient  has  been,  we  think,  very  properly  acquitted,  on  the 
ground  of  temporary  insanity;  having  herself  voluntarily  confessed  the  act  with 
the  deepest  remorse,  at  the  same  time  declaring  her  utter  incapacity  to  account  for 
the  wild  and  savage  fury  which  seized  her  at  the  momentof  delivery." — Righyh 
Midvjifery.  T.  R.  B. 

79.  Antidote  to  Corrosive  Sublimate, — M.  Mialhe,  in  a  note  read  to  the  Aca- 
demy of  Medicine,  of  Paris,  Aug.  16,  states,  as  the  results  from  his  experiments, 
that  the  hydrated  proto-sulphate  of  iron  (a  substance  quite  innocuous)  possesses 
the  property  of  instantly  decomposing  corrosive  sublimate.  The  products  of 
the  decomposition  are  the  proto-chloride  of  iron  and  the  bisulphate  of  mercury, 
inert  substances. 


ORGANIC  CHEMISTRY. 

80.  Organic  Chemistry  applied  to  Physiology  and  Pathology. — Dr.  Playfair 
read  to  the  British  Association,  at  their  last  meeting,  the  following  abstract  of 
Professor  Liebig's  Report  on  Organic  Chemistry,  applied  to  Physiology  and 
Pathology: — Professor  Liebig  had  been  requested,  some  few  years  ago,  to  apply 
himself  to  the  consideration  of  vegetable  and  animal  physiology.  The  Professor's 
first  Report  had  been  read  at  the  meeting  of  the  Association  at  Glasgow,  in  1840. 
The  second  he  was  about  to  bring  before  their  notice.  And  in  a  third,  the  Pro- 
fessor intended  to  apply  the  principles  of  organic  chemistry  to  diet  and  dietetics; 
and  under  this  head  would  be  comprised  the  nutritiveness  of  particular  vegetables 
in  the  fattening  of  cattle.  The  first  part  of  Professor  Liebig's  Report  consisted 
of  the  examination  of  the  processes  employed  in  the  nutrition  and  reproduction  of 
the  various  parts  of  the  animal  economy.  In  vegetables,  as  well  as  in  animals, 
■we  recognise  the  existence  of  a  force  in  a  state  of  rest.  It  is  the  primary  cause 
of  growth  or  increase  in  the  mass  of  the  body  in  which  it  resides.  By  the  actioa 
of  external  influences,  such  as  by  the  pressure  of  air  and  moisture,  its  condition 
of  static  equilibrium  is  disturbed;  and  entering  into  a  state  of  motion  or  activity, 
it  occupies  itself  in  the  production  of  forms.  This  force  has  received  the  appel- 
lation o^  vital force^  or  vitality.  Vitality,  though  residing  equally  in  the  animal 
and  vegetable  kingdoms,  produces  its  effects  by  widely  different  instruments. 
Plants  subsist  entirely  upon  manures  belonging  to  inorganic  nature.  Atmo- 
spheric air,  the  source  whence  they  derive  their  nutriment,  is  considered  to  be  a 
mineral  by  the  most  distinguished  mineralogists.  All  substances,  before  they 
can  form  food  for  plants,  must  be  resolved  into  inorganic  matter.  But  animals, 
on  the  other  hand,  require  highly  organized  atoms  for  nutriment.  They  can 
only  subsist  upon  parts  of  an  organism.  They  possess  within  them  a  vegetative 
life,  as  plants  do,  by  means  of  which  they  increase  in  size,  without  conscious- 
ness on  their  part;  but  they  are  distinguished  from  vegetables,  by  their  faculties 
of  locomotion  and  sensation — faculties  acting  through  a  nervous  apparatus.  The 
true  vegetable  life  of  animals  is  in  no  way  dependent  upon  this  apparatus,  for  it 
proceeds  when  the  means  of  voluntary  motion  and  sensation  are  destroyed;  and 
the  most  energetic  volition  is  incapable  of  exerting  any  influence  on  the  contrac- 
tions of  the  heart,  on  the  motion  of  the  intestines,  or  on  the  processes  of  secretion. 
All  parts  of  the  animal  body  are  produced  from  the  fluid  circulating  within  its 


1842.]  s        Organic  Chemistry,  497 

organism,  by  virtue  of  vitality,  which  resides  in  every  organ.  A  destruction  of 
the  animal  body  is  constantly  proceeding.  Every  motion,  every  manifestation 
offeree,  is  the  result  of  the  transformation  of  the  structure,  or  of  its  substance. 
Every  conception,  every  mental  affection,  is  followed  by  changes  in  the  chemical 
nature  of  the  secreted  fluids.  Every  thought,  every  sensation,  is  accompanied 
by  a  change  in  the  composition  of  the  substance  of  the  brain.  It  is  to  supply 
the  waste  thus  produced  that  food  is  necessary.  Food  is  either  applied  in  the 
increase  of  the  mass  of  a  structure,  (that  is,  in  nutrition,)  or  it  is  applied  in  the 
replacement  of  a  structure  wasted,  (that  is,  in  reproduction.)  The  primary  con- 
dition for  the  existence  of  life  is  the  reception  and  assimilation  of  food.  But 
there  is  another  condition  equally  important — the  continual  absorption  of  oxygen 
from  the  atmosphere.  All  vital  activity  results  from  the  mutual  action  of  the 
oxygen  of  the  atmosphere  and  the  elements  of  the  food.  All  changes  in  mattet 
proceeding  in  the  body  are  essentially  chemical,  although  they  are  not  unfre- 
quently  increased  or  diminished  in  intensity  by  the  vital  force.  The  influence 
of  poisons  and  remedial  agents  on  the  animal  economy  proves,  that  the  chemical 
combinations  and  decompositions  proceeding  therein,  and  which  manifest  them- 
selves in  the  phenomena  of  vitality,  may  be  influenced  by  bodies  having  a  well- 
defined  chemical  action.  Vitality  is  the  ruling  agent  by  which  the  chemical 
powers  are  made  to  subserve  its  purposes;  but  the  acting  forces  are  chemical. 
It  is  from  this  view,  and  another,  that  we  ought  to  view  vitality.  According  to 
Lavoisier,  an  adult  man  takes  into  his  system,  every  year,  837  lb.  of  oxygen, 
and  yet  he  does  not  increase  in  weight.  What,  then,  becomes  of  the  enormous 
quantity  of  oxygen  introduced  in  the  course  of  the  year  into  the  human  system? 
The  carbon  and  hydrogen  of  certain  parts  of  the  body  have  entered  into  combi- 
nation with  the  oxygen  introduced  through  the  lungs  and  through  the  skin,  and 
have  been  given  out  in  the  form  of  carbonic  acid,  and  the  vapour  of  water.  At 
every  moment,  with  every  expiration,  parts  of  the  body  are  thus  removed,  and 
are  emitted  into  the  atmosphere.  No  part  of  the  oxygen  inspired  is  again  ex- 
pired as  such.  Now,  it  is  found  that  an  adult  inspires  32^  oz.  of  oxygen  daily. 
This  w\\\  convert  the  carbon  of  24  lb.  of  blood  into  carbonic  acid.  He  must,^ 
therefore,  take  as  much  nutriment  as  will  supply  this  daily  loss;  and,  in  fact,  it 
is  found  that  he  does  so;  for  the  average  amount  of  carbon  in  the  daily  food  of  an 
adult  man,  taking  moderate  exercise,  is  14  oz.,  which  require  37  oz.  of  oxygen 
for  their  conversion  into  carbonic  acid.  But  it  is  obvious,  as  the  inspired  oxygen 
can  be  removed  only  by  its  conversion  into  carbonic  acid  and  water,  that  the 
amount  of  food  necessary  for  the  support  of  the  animal  body  must  be  in  direct 
ratio  to  the  quantity  of  oxygen  taken  into  the  system.  Thus,  a  child,  in  whom 
the  organs  of  respiration  are  naturally  in  a  state  of  great  activity,  requires  food 
more  frequently,  and  in  greater  proportion  to  the  bulk  than  an  adult,  and  is  also  less 
patient  of  hunger.  A  bird  deprived  of  food  dies  on  the  third  day;  whilst  a  ser- 
pent, which  inspires  but  a  mere  trace  of  oxygen,  can  live  without  food  for  three 
months.  The  capacity  of  the  chest  in  an  animal,  is  a  constant  quantity.  We 
therefore  inspire  the  same  volume  of  air,  whether  at  the  pole  or  the  equator.  But 
the  weight  of  the  air,  and  consequently  of  the  oxygen,  varies  with  the  tempera- 
ture. Thus,  an  adult  man  takes  into  the  system  daily  46,000  cubic  inches  of 
oxygen,  which,  if  the  temperature  be  77  deg.,  weigh  32^  oz.;  but,  when  the 
temperature  sinks  down  to  the  freezing  point,  (32  deg.)  it  wnll  weigh  35  oz. 
Thus,  an  adult  in  our  climate  in  winter  may  inhale  35  oz.  of  oxygen;  in  Sicily 
he  would  inspire  only  28^.;  and  if  in  Sweden,  36  oz.  Hence,  we  inspire  more 
carbon  in  cold  weather,  when  the  barometer  is  high,  than  we  do  in  warm  weather; 
and  we  must  consume  more  or  less  carbon  in  our  food  in  the  same  proportion. 
In  our  own  climate,  the  difference  between  summer  and  winter,  in  the  carbon 
expired,  and  therefore  necessary  for  food,  is  as  much  as  an  eighth.  Even  when 
we  consume  equal  weights  of  food,  an  infinitely  wise  Creator  has  so  adjusted  it 
as  to  meet  the  exigencies  of  climate.  Thus,  the  fruit  on  which  the  inhabitants 
of  the  south  delight  to  feed,  contains  only  12  per  cent,  of  carbon,  whilst  the 
bacon  and  train  oil  enjoyed  by  the  inhabitants  of  the  arctic  regions,  contain  from 
66  to  80  per  cent,  of  the  same  element.     Now  the  mutual  action  between  the 

42* 


498  Progress  of  the  Medical  Sciences.  [Oct. 

elements  of  food  and  the  oxygen  of  the  air,  is  the  source  of  animal  heat.  All 
living  creatures,  whose  existence  depends  on  the  absorption  of  oxygen,  possess 
within  themselves  a  source  of  heat,  independent  of  the  medium  in  which  they 
exist.  This  heat,  in  Prof.  Liebig's  opinion,  is  wholly  due  to  the  combustion  of 
the  carbon  and  hydrogen  contained  in  the  food  which  they  consume.  Animal 
heat  exists  only  in  those  parts  of  the  body  through  which  arterial  blood  (and 
with  it  oxygen  in  solution)  circulates.  The  carbon  and  hydrogen  of  food,  in 
being  converted  by  oxygen  into  carbonic  acid  and  water,  must  give  out  as  much 
heat  as  if  they  were  burned  in  the  open  air.  The  only  difference  is,  that  this  heat 
is  spread  over  unequal  spaces  of  time;  but  the  actual  amount  is  always  the  same. 
The  temperature  of  the  human  body  is  the  same  in  the  torrid  as  in  the  frigid 
zone.  But,  as  the  body  may  be  considered  in  the  light  of  a  heated  vessel, 
which  cools  with  an  accelerated  rapidity  the  colder  the  surrounding  medium, 
it  is  obvious  that  the  fuel  necessary  to  retain  its  heat  must  vary  in  different 
climates.  Thus,  less  heat  is  necessary  in  Palermo,  where  the  temperature  of 
the  air  is  that  of  the  human  body,  than  in  the  polar  regions,  where  it  is  about 
90°  lower.  In  the  animal  body,  the  food  is  the  fuel;  and,  by  a  proper  supply 
of  oxygen,  we  obtain  the  food  given  out  during  its  combustion  in  winter.  When 
we  take  exercise  in  a  cold  atmosphere,  we  respire  a  greater  amount  of  oxygen, 
which  implies  a  more  abundant  supply  of  carbon  in  the  food:  and,  by  taking  this 
food,  we  form  a  most  efficient  protection  against  the  cold.  A  starving  man  is 
soon  frozen  to  death;  and  every  one  knows  that  the  animals  of  prey  of  the  arctic 
regions  are  far  more  voracious  than  those  of  the  torrid  zone.  Our  clothing  is 
merely  an  equivalent  for  food;  and  the  more  warmly  we  are  clothed,  the  less 
food  we  require.  Were  we  to  go  destitute  of  clothes,  like  certain  savage  tribes, 
— or  if,  in  hunting  or  fishing,  we  were  exposed  to  the  same  degree  of  cold  as 
the  Samoyedes,— we  could  with  ease  consume  10  lb.  of  flesh,  and,  perhaps,  a 
dozen  tallow  candles  into  the  bargain;  as  warmly  clad  travellers  have  related, 
with  astonishment,  of  those  people.  Then  could  we  take  the  same  quantity  of 
brandy  or  blubber  of  fish  without  bad  effects,  and  learn  to  appreciate  the  delicacy 
of  train  oil.  We  thus  perceive  the  reason  of  the  apparently  anomalous  habits 
of  different  nations.  The  macaroni  of  the  Italian,  and  the  train  oil  of  the  Green- 
lander  and  the  Russian,  are  not  adventitious  freaks  of  taste,  but  necessary  articles 
fitted  to  administer  to  their  comfort  in  the  climates  in  which  they  have  been  born. 
The  colder  the  region,  the  more  combustible  must  the  food  be.  The  Englishman 
in  Jamaica  perceives  with  regret  the  disappearance  of  his  appetite,  which,  in 
Eno-land,  had  been  a  constant  recurring  source  of  enjoyment.  By  the  use  of 
aromatics  he  creates  an  artificial  appetite,  and  eats  as  much  food  as  he  did  at 
home.  But  he  thus  unfits  himself  for  the  climate  in  which  he  is  placed;  for 
sufficient  oxygen  does  not  enter  his  system  to  combine  with  the  carbon  con- 
sumed; and  the  heat  of  the  climate  prevents  him  taking  exercise  to  increase  the 
number  of  his  respirations.  The  carbon  of  the  food  is  therefore  forced  into  other 
channels,  and  disease  results.  England,  on  the  other  hand,  sends  her  dyspeptic 
patients  to  southern  climates.  In  our  own  land  their  impaired  digestive  organs 
are  unable  to  fit  the  food  for  that  state  in  which  it  best  unites  w^ith  the  oxygen 
of  the  air,  which  therefore  acts  on  the  organs  of  respiration  themselves,  thus 
producing  pulmonary  complaints.  But  when  they  are  removed  to  warmer  cli- 
mates, they  absorb  less  oxygen,  and  take  less  food;  and  the  diseased  organs  of 
digestion  have  sufficient  power  to  place  the  diminished  amount  of  food  in  equi- 
librium with  the  respired  oxygen.  Just  as  we  would  expect  from  these  views, 
in  our  own  climate  hepatic  diseases,  or  diseases  arising  from  excess  of  carbon, 
are  more  prevalent  in  summer,  and  in  winter  pulmonic  diseases,  or  those  arising 
from  excess  of  oxygen.  The  Professor  then  went  on  to  disprove  the  notion,  that 
animal  heat  is  due  to  nervous  influence,  and  not  to  combustion,— an  error  which 
had  its  origin  in  supposing  that  the  combustion  proceeds  in  the  blood  itself.  He 
also  showed,  that  animal  heat  must  not  be  ascribed  to  the  contraction  of  the 
muscles.  The  Professor  proceeds  to  prove,  that  the  heat  evolved  by  the  com- 
bustion of  carbon  in  the  body  is  sufficient  to  account  for  the  phenomena  of  animal 
heat.     He  shows  that  the  14  ounces  of  carbon  which  are  daily  converted  into 


1842.]  Organic  Chemistry.  499 

carbonic  acid,  in  an  adult,  disengage  no  less  than  197*477°  of  heat;  a  quantity 
which  would  convert  24  lb.  of  water,  at  the  temperature  of  the  body,  into  vapour. 
And  if  we  assume  that  the  quantity  of  water  vaporized  through  the  skin  and 
lungs  amounts  to  3  lb.,  then  we  have  still  140  380°  of  heat  to  sustain  the  tem- 
perature of  the  body.  And  when  we  take  into  calculation  the  heat  evolved  by 
the  hydrogen  of  the  food,  and  the  small  specific  heat  possessed  by  the  organs 
generally,  no  doubt  could  be  entertained  that  the  heat  evolved  in  the  process  of 
combustion,  to  which  the  food  is  subjected  in  the  body,  is  amply  sufficient  to 
explain  the  constant  temperature  of  the  body.  From  what  has  preceded,  it  is 
obvious  that  the  amount  of  carbon  consumed  in  food  ought  to  depend  on  the 
climate,  density  of  air,  and  occupation  of  the  individual.  A  man  will  require 
less  carbon  when  pursuing  a  sedentary  occupation,  than  when  he  is  engaged  in 
active  exercise.  Professor  Liebig,  having  thus  discussed  the  source  of  animal 
heat,  proceeds  next  to  consider  what  are  the  ingredients  in  the  food,  which  may 
properly  be  considered  to  be  nutritious.  Physiologists  conceive  that  the  various 
organs  in  the  body  have  originally  been  formed  with  blood.  If  this  be  admitted, 
it  is  obvious  that  those  substances  only  can  be  considered  as  nutritious  which 
are  susceptible  of  being  transformed  into  blood.  The  Professor  then  entered 
upon  an  examination  of  the  composition  of  blood,  and  of  the  identity  in  chemical 
constitution  of  fibrine  and  albumen.  The  nutritive  process  is  simplest  in  the 
case  of  the  carnivora.  This  class  of  animals  lives  on  the  blood  and  flesh  of  the 
graminivora,  whose  blood  and  flesh  are  identical  with  their  own.  In  a  chemical 
sense,  therefore,  a  carnivorous  animal,  in  taking  food,  feeds  upon  itself,  for  the 
nutriment  is  identical  in  composition  with  its  own  tissues.  The  Professor  then 
inquired  from  what  constituents  of  vegetables  the  blood  of  the  graminivorous 
animals  is  produced.  The  nitrogenized  compounds  of  vegetables  forming  the 
food  of  graminivorous  animals  are  called  vegetable  fibrine,  vegetable  albumen, 
and  vegetable  caseine.  Now,  analysis  has  led  to  the  interesting  result,  that 
they  are  exactly  of  the  same  composition  in  100  parts;  and,  what  is  still  more 
extraordinary,  they  are  absolutely  identical  with  the  chief  constituents  of  the 
blood — animal  fibrine  and  animal  albumen.  By  identity,  be  it  remarked,  we  do 
not  imply  similarity,  but  absolute  identity,  even  as  far  as  their  inorganic  con- 
stituents are  concerned.  These  considerations  showed  the  beautiful  simplicity 
of  nutrition.  In  point  of  fact,  vegetables  produce,  in  their  organism,  the  blood 
of  all  animals.  Animal  and  vegetable  life  are  therefore  most  closely  connected. 
The  Professor  has  still  to  account  for  the  use  of  the  substances  in  food  which 
are  absolutely  destitute  of  nitrogen;  but  which  we  know  are  absolutely  necessary 
to  animal  life.  In  all  these  we  find  a  great  excess  of  carbon,  and  but  very  little 
oxygen.  By  a  train  of  admirable  reasoning,  the  Professor  arrives  at  the  interest- 
ing conclusion,  that  they  are  solely  exhausted  in  the  production  of  animal  heat, 
being  converted  by  the  oxygen  of  the  air  into  carbonic  acid  and  water.  This 
portion  of  the  report  contained  an  ingenious  and  important  view  of  the  use  of 
bile  in  the  animal  economy,  the  truth  of  which  quantative  physiology  dare  not 
deny.  When  exercise  is  denied  to  graminivorous  and  omnivorous  animals,  this 
is  tantamount  to  a  deficient  supply  of  oxygen.  The  carbon  of  the  food  not 
meeting  with  sufficient  oxygen  to  consume  it,  it  passes  into  the  compounds  con- 
taining a  large  excess  of  carbon  and  deficiency  of  oxygen;  or,  in  other  words, 
fat  is  produced.  Liebig  concludes,  that  fat  is  altogether  an  abnormal  and  un- 
natural production,  arising  from  the  adaptation  of  nature  to  circumstances,  and 
not  of  circumstances  to  nature, — altogether  arising  from  a  disproportion  of  carbon 
in  the  food  to  that  of  the  oxygen  respired  by  the  lungs,  or  absorbed  by  the  skin. 
Wild  animals  in  a  state  of  nature  do  not  contain  fat.  The  Bedouin,  or  Arab  of 
the  Desert,  who  shows  with  pride  his  lean,  muscular,  sinewy  limbs,  is  altogether 
free  from  fat.  And  the  Professor  points  out  the  diseases  arising  from  this  cause. 
From  all  that  has  transpired,  we  may  sum  up  the  nutritious  elements  of  food  as 
follows.  The  ingredients  adapted  for  the  formation  of  the  blood,  and  which  the 
Professor  calls  the  plastic  elements  of  nutrition,  are  as  follows: — vegetable 
fibrine,  vegetable  albumen,  vegetable  caseine,  animal  flesh,  animal  blood.  The 
other  ingredients  of  food  being  fitted  to  retain  the  temperature  of  the  body,  he 


500  Progress  of  the  Medical  Sciences.  [Oct. 

calls  the  elements  of  respiration.  They  are — fat,  starch,  gum,  cane  sugar,  grape 
sugar,  sugar  of  milk,  pectine,  bassorine,  beer,  wine,  spirits.  These  are  Pro- 
fessor Liebig's  general  principles  of  nutrition.  The  second  part  of  the  work 
consists  of  details,  in  which  he  examines  the  chemical  processes  engaged  in  the 
production  of  bile,  of  urea,  uric  acid  and  its  compounds,  as  well  as  of  cerebral 
and  nervous  substance.  The  conclusions  to  which  he  has  arrived  on  the  subjects 
are  of  such  great  and  startling  interest,  that  Dr.  Playfair  said,  he  dared  not  ven- 
ture to  make  an  abstract  of  them,  without  entering  into  the  calculations  with 
which  they  were  accompanied.  In  the  Professor's  explanatory  remarks  on 
digestion,  he  ascribes  a  singular  function  to  saliva.  This  fluid  possesses  the 
remarkable  property  of  enclosing  air  in  the  shape  of  froth,  in  a  far  higher  degree 
even  than  soap  suds.  This  air,  by  means  of  the  saliva,  accompanies  the  food 
into  the  stomach,  and  there  its  oxygen  enters  into  combination  with  the  consti- 
tuents of  the  food,  whilst  its  nitrogen  is  again  given  out  through  the  lungs  or 
skin.  The  longer  digestion  continues,  the  greater  is  the  quantity  of  saliva,  and 
consequently  of  air,  which  enters  the  stomach.  Rumination,  in  certain  grami- 
nivorous animals,  has  plainly  for  one  object  a  renewed  and  repeated  introduction 
of  oxygen.  The  Professor  further  touches  upon  the  use  of  tea  and  coffee  as  an 
article  of  food.  Recent  chemical  research  has  proved,  that  the  active  principles 
of  tea  and  coffee — viz.  teine  and  caffeine, — are  absolutely  one  and  the  same 
body,  perfectly  identical  in  every  respecj..  The  action  of  tea  and  coffee  on  the 
system  must  be  therefore  the  same.  How  is  it  that  the  practice  of  taking  them 
has  become  necessary  to  whole  nations'?  Caffeine  (teine)  is  a  highly  nitrogenized 
body.  Bile,  as  is  well  known,  contains  an  essential  nitrogenized  ingredient — 
taurine.  Now,  Professor  Liebig  considers,  that  caffeine  goes  to  the  production 
of  this  taurine;  and  if  an  infusion  of  tea  contains  only  one-tenth  of  a  grain  of 
caffeine,  still  if  it  contribute,  in  point  of  fact,  to  the  formation  of  bile,  the  action 
even  of  such  a  quantity  cannot  be  looked  upon  as  a  nullity.  Neither  can  it  be 
denied,  that,  in  case  of  using  an  excess  of  non-azotized  food,  or  deficiency  of 
motion,  which  is  required  to  cause  the  change  of  matter  in  the  tissues,  and  thus 
to  yield  nitrogenized  matter  of  the  bile,  that  in  such  a  condition  the  state  of 
health  may  be  benefited  by  the  use  of  tea  or  coffee,  by  which  may  be  furnished 
the  nitrogenized  product  produced  in  the  healthy  state  of  the  body,  and  essential 
to  the  production  of  an  important  element  of  respiration.  The  American  Indian, 
with  his  present  habits  of  living  solely  on  flesh,  could  not  with  any  comfort  use 
tea  as  an  article  of  food;  for  his  tissues  waste  with  such  rapidity  that,  on  the 
contrary,  he  has  to  take  something  to  retard  this  waste.  And  it  is  worthy  of 
remark,  that  he  has  discovered  in  tobacco  smoke  a  means  of  retarding  the  change 
of  matter  in  the  tissues  of  his  body,  and  thereby  of  making  hunger  more  endur- 
able. Nor  can  he  withstand  the  captivation  of  brandy,  which,  acting  as  an 
element  of  respiration,  puts  a  stop  to  the  change  of  matter,  by  performing  the 
function  which  properly  belongs  to  the  products  of  the  metamorphosed  tissues. 
The  third  part  of  Professor  Liebig's  Report  treats  of  the  recondite  laws  of  the 
phenomena  of  motion.  As  it  is  principally  of  a  speculative  character,  we  can 
pass  this  over.  The  Professor  concludes  his  communication  by  two  chapters: 
one  on  the  theory  of  disease;  the  other  on  the  theory  of  respiration.  The  whole 
life  of  animals  consists  of  a  conflict  between  chemical  forces  and  the  vital  powers. 
In  the  normal  state  of  the  body  of  an  adult,  both  stand  in  equilibrium.  Every 
mechanical  or  chemical  agency  which  disturhs  the  restoration  of  this  equilibrium 
is  a  cause  af  disease.  Disease  occurs  when  the  resistance  offered  by  the  vital 
force  is  weaker  than  the  acting  cause  of  disturbance.  Death  is  that  condition 
in  which  chemical  or  mechanical  powers  gain  the  ascendancy,  and  all  resistance 
on  the  part  of  the  vital  force  ceases.  Every  abnormal  condition  of  supply  or 
waste  may  be  called  disease.  It  is  evident  that  one  and  the  same  cause  of 
disease — that  is,  of  disturbance — will  have  different  effects,  according  to  the 
period  of  life.  A  cause  of  disease,  added  to  the  cause  of  waste,  may  in  old  age 
annihilate  the  resistance  of  the  vital  powers,  or,  in  other  words,  occasion  death; 
while,  in  the  adult  state,  it  may  produce  only  a  disproportion  between  supply 
and  waste;  and  in  infancy  only  an  abstract  state  of  health,  i.  e.  an  equilibrium 


1842.]  Organic  Chemistry.  501 

between  supply  and  waste.  Professor  Liebior  argues,  from  wbat  bas  preceded, 
that  a  deficiency  of  resistance  in  a  living  part  to  the  cause  of  waste,  is  in  fact  a 
deficiency  of  resistance  to  the  action  oif  the  oxygen  of  the  atmosphere.  The 
Professor's  theory  may  be  compared  to  a  self-regulating  steam-engine.  The 
body,  in  regard  to  the  production  of  heat  and  of  force,  acts  just  like  one  of  those 
machines.  With  the  lowering  of  the  external  temperature,  the  respiration  be- 
comes deeper  and  more  frequent;  oxygen  is  supplied  in  greater  quantity,  and  of 
greater  density;  the  change  of  matter  is  increased,  and  more  food  must  be  sup- 
plied, if  the  temperature  of  the  body  is  to  remain  unchanged.  It  has  been  proved, 
that  iron  is  not  necessary  to  the  colouring  matter  of  the  blood,  but  that  it  forms 
an  essential  constituent  of  blood  globules.  These  globules,  it  is  well  known, 
take  no  part  in  nutrition.  Professor  Liebig  conceives,  that  the  iron  is  the  great 
means  of  conveying  to  the  lungs  the  carbonic  acid  formed  in  the  system;  and  he 
has  made  a  calculation,  that  the  iron  contained  in  the  body  could  actually  convey 
twice  as  much  carbonic  acid  as  is  expelled  daily  from  the  system. — Lond.  and 
Edin.  Month.  Journ.  Med.  Set.  Aug.  1842. 

81.  Azotized  Nutritive  Principles  of  Plants.  By  M.  Liebig. — Vegetable  albu- 
men, gluten,  and  legumen,  to  which  might  be  added  vegetable  fibrine,  are,  pro- 
perly speaking,  the  azotized  nutritive  principles  of  plants.  Vegetable  albumen, 
which  is  distinguished  by  its  solubility  in  water,  is  found  in  the  juices  of  plants, 
but  chiefly  in  oleaginous  seeds.  Gluten  is  one  of  the  chief  ingredients  of  the 
seeds  of  the  cereals.  Legumen  is  chiefly  found  in  the  leguminous  plants,  as 
beans,  peas,  &c.  These,  with  another  substance  which  M.  Liebig  terms  vege- 
table fibrine,  form  the  proper  nutriment  of  graminivorous  animals,  from  which 
their  blood  is  produced,  and  from  which  all  the  azotized  portions  of  their  bodies 
take  their  rise.  It  is  in  the  vegetable  kingdom  that  the  nourishment  of  animals 
is  in  general  prepared;  for  strictly  speaking,  carnivorous  animals,  when  they 
consume  other  animals  which  have  fed  on  vegetables,  consume  only  those  vege- 
table principles  which  have  served  the  latter  as  nourishment.  Every  azotized 
animal  substance  has  consequently  its  origin  in  plants. 

In  carnivorous  animals,  the  process  of  nutrition  is  very  simple,  the  nourish- 
ment they  take  is  identically  the  same  as  the  principal  component  parts  of  their 
own  bodies.  The  flesh,  blood,  membranes,  &c.  which  they  consume  are  in  no 
respect  diflferent  (chemically  speaking)  from  their  own  flesh  and  blood.  The 
food  of  carnivorous  animals  assumes  a  new  form  in  the  stomach  and  organs  of 
digestion,  but  its  chemical  composition  suffers  no  change;  it  is  simply  made 
soluble,  and  thus  becomes  transferable  to  the  diflTerent  parts  of  the  body,  taking 
again  the  form  of  blood  from  which  it  originated.  The  vital  action  of  these 
organs  in  digestion  and  the  formation  of  blood  in  this  class  of  animals  seems 
to  be  confined  to  a  mere  change  in  the  condition  of  the  nutritive  matter,  as  it  is 
incapable  of  assimilation  in  the  state  in  which  it  is  taken. 

The  process  of  nutrition  in  graminivorous  animals  appears  much  more  com- 
plicated, and  the  food  has  much  less  resemblance  to  the  constituents  of  their 
bodies. 

All  plants  which  nourish  graminivorous  animals  contain,  besides  the  azotized 
compounds  named,  certain  others  absolutely  necessary  for  the  support  of  life, 
which  yet  contain  no  nitrogen.  These  compounds  are  evidently  applied  to 
some  particular  purpose,  as  they  disappear  in  the  organization,  they  without 
doubt  take  a  part  in  certain  processes  which  in  carnivorous  animals  are  con- 
ducted in  a  different  manner. 

After  a  succinct  theoretical  investigation  of  the  mode  in  which  these  different 
vegetable  principles  would  require  to  yield  to  one  another  the  elements  of  which 
they  are  composed,  if  one  or  other  did  not  possess  the  exact  same  composition 
as  the  animal  solids  or  fluids,  he  shows  by  an  elaborate  chemical  investigation 
that  their  vegetable  principles  undergo  no  chemical  change  in  being  assimilated 
to  the  animal  structures.  He  first  states  the  latest  experiments  made  on  the 
animal  proximate  principles,  j/?6rme,  albumen^  and  casein^  which  demonstrate 
that  they  possess  the  same  exact  amount  of  elementary  principles;  and  on  com- 
paring "the  composition  of  azotized  vegetable  substances  with  the  principal 


502 


Progress  of  the  Medical  Sciences, 


[Oct. 


component  parts  of  animals,  a  most  important  fact  is  at  once  discovered,  namely, 
that  all  those  nutritive  vegetable  principles,  whatever  they  may  be,  possess 
either  the  same  composition  as  fibrine,  albumen,  and  casein,  or  if  the  per  centage 
be  different,  still  have  the  same  proportion  of  nitrogen  and  carbon  as  the  animal 
substances  possess.  It  is  remarkable  also  that  this  resemblance  goes  still  far- 
ther, for  these  vegetable  substances  conduct  themselves  in  a  similar  manner 
with  chemical  reagents,  so  that  we  may  say  that  their  form  is  merely  changed 
when  animals  produce  blood  and  muscular  fibre  from  them;  for  they  are  ob- 
tained from  plants  in  a  perfect  state  as  far  as  the  proportion  of  their  elements  is 
concerned.  Graminivorous  animals  are  fed  on  vegetable  albumen,  fibrine,  and 
casein,  which  have  therefore,  chemically  considered,  the  same  composition,  and 
in  most  cases,  the  same  properties  as  their  own  blood,  albumen,  and  muscular 
fibre." 

We  must  refer  to  the  paper  itself  for  the  lengthened  and  numerous  chemical 
details  regarding  the  identity  of  these  vegetable  principles,  with  those  of  the 
animal  body,  and  merely  state  that  he  proves  both  from  their  chemical  reactions 
and  from  the  ultimate  analysis,  their  identity.  We  copy  one  analysis  of  each 
of  these  vegetable  substances  to  contrast  with  those  of  the  animal  principles. 


Carbon, 

Nitrogen, 

Hydrogen, 

Oxygen, 

Sulphur, 

Phosphorus, 


Fibrin. 

54-603 

15-810 

7-491 

22-096 


Vegetable  Principles, 

Albumen.  Casein. 

54-74  54138 

15-85  15-672 

7-77          ■  7-156 

21-64  23-034 


Gluten. 

55.22 

15.98 

7-42 

21-38 


Carbon, 

Nitrogen, 

Hydrogen, 

Oxygen, 

Sulphur, 

Phosphorus, 


Animal  Principles, 

Fibrin.  Albumen. 

54-56  54-48 

15-72  15-70 

6-90  7-01 


22-82 


22-81 


Casein. 

54-96 

15-80 

7-15 

22-09 


From  the  facts  which  he  states,  M.  Liebig  draws  many  interesting  physio- 
logical conclusions,  some  of  which  are  speculative,  others  founded  on  facts; 
and  mentions  it  as  a  remarkable  fact,  that  even  the  inorganic  ingredients  are  the 
same  in  both  the  animal  and  vegetable  kingdoms. — When  burnt,  both  leave 
similar  ashes. 

"Animals,"  says  Liebig,  "are  distinguished  from  plants  by  their  capability 
of  moving  from  place  to  place,  by  their  sensations  and  sensibility,  or  in  one 
word,  by  their  senses;  for  all  these  purposes  certain  organs  are  required,  which 
are  entirely  wanting  in  plants.  The  same  active  principle,  however,  gives  to 
the  bud,  the  leaves,  and  the  fibres  of  the  root,  the  same  wonderful  properties. 
The  plant  is  alive  as  truly  as  any  part  of  the  living  animal  body.  They  both 
receive  on  the  same  principle,  the  properties  of  growth,  reproduction,  and  the 
power  of  replacing  in  the  system  what  has  been  consumed.  Of  these  proper- 
ties vegetable  life  consists,  it  is  developed  without  consciousness. 

"Chemically  speaking,  animal  life,  though  of  an  infinitely  higher  rank, 
generates  only  the  substance  of  the  nerves  and  of  the  brain,  which  are  alto- 
gether wanting  in  plants.  Although  animals  receive  from  vegetables  all  the 
ingredients  requisite  for  the  formation  of  blood,  and  cannot  by  their  own  organi- 
zation generate  them  from  carbonic  acid  and  ammonia  as  plants  do,  the  power 
belongs  to  them  alone  of  producing  those  bodies  of  a  higher  order,  such  as  the 
complex  constituents  of  the  brain,  the  spinal  marrow,  and  the  nerves.  Animals 
must  have  peculiar  organs  for  the  exercise  of  the  will,  the  feelings,  and  locomo- 
tion; and  these  organs  must  be  produced  from  that  part  to  which  the  impulse  is 
given.     Physiology  gives  us  no  decided  information  on   these  points.     The 


1842.]  Organic  Chemistry,  503 

spleen  and  the  numerous  glands  must  all  have  some  part  to  perform  in  the  body, 
and  a  necessary  one  too,  or  they  certainly  would  not  exist. 

*»The  growth  of  plants  depends  on  the  continual  supply  of  carbon  and  two 
other  elements;  and  this  supply  is  obtained  by  the  separation  of  oxygen  from 
the  ingredients  of  their  food.  The  growth  of  the  organs  of  a  graminivorous 
animal  must  depend  also  on  a  similar  separation  of  oxygen.  But  we  know,  on 
the  contrary,  that  the  life  of  animals  is  characterized  by  a  constant  absorption 
of  oxygen,  although  it  does  not  remain  in  the  body;  and  it  is  known,  from  a 
number  of  simple  facts,  that,  besides  the  oxygen  of  the  atmosphere,  which 
escapes  in  combination  with  carbon,  another  portion  arising  from  the  food  must 
escape  also,  under  certain  circumstances,  as  carbonic  acid. 

*'This  last  oxygen  arises  from  nutriment,  which  contains  no  nitrogen,  when 
fat  is  formed.  Starch,  sugar,  and  gum,  cannot  be  used  by  animals  for  the 
formation  of  blood  or  muscular  fibre,  because  the  azotized  nourishment  they 
receive  contains  all  that  is  wanted.  The  membranes,  the  cellular  tissue,  skin, 
horn,  and  the  claws  of  animals,  contain  more  nitrogen  in  proportion  to  their 
carbon,  than  albumen  or  fibrine.  These  latter  (albumen  and  fibrine)  must  give 
up  a  certain  portion  of  their  carbon,  if  the  former  (cellular  tissue,  &c.)  are 
formed  from  the  blood;  that  they  are  produced  from  substances  with  no  nitrogen 
is  impossible. 

"  Now  we  find  that  the  flesh  of  graminivorous  animals,  and  especially  of 
domestic  animals,  which  eat  a  great  deal  of  food  without  nitrogen,  is  very  fat, 
and  that  this  fat  may  be  increased  by  increasing  the  supply  of  this  kind  of  food. 
The  flesh  of  carnivorous  animals  is  without  fat  and  sinewy:  all  the  food  which 
they  eat  contains  nitrogen,  except  the  fat  of  the  animals  they  devour. 

"It  is  evident  that  starch,  sugar,  and  gum,  are  incapable  of  supplying  that 
loss  which  is  continually  occasioned  in  animals  by  the  vital  powers;  they  are 
incapable  of  forming  muscular  fibre,  cerebral  matter,  the  membranes,  or  the 
bones  and  sinews,  because  their  only  elements  are  carbon,  and  the  elements  of 
water.  Children  fed  on  such  food  become  very  fat,  but  neither  their  muscles 
nor  their  bones  can  increase,  and  they  themselves  therefore  cannot  become 
stronger." 

M.  Liebig  then  gives  the  chemical  analysis  of  the  fat  of  the  pig,  of  sheep, 
and  of  man,  and  shows  that  it  contains  the  same  proportions  of  carbon  and 
hydrogen  as  exist  in  amylin,  sugar,  and  gum,  so  that,  merely  by  giving  up  part 
of  the  oxygen,  these  vegetable  principles  may  become  fat,  "the  only  substance 
which  contains  no  nitrogen  in  the  animal  organization." 

The  fat,  says  M.  Liebig,  must  have  some  use,  and  he  inquires  whether  a 
certain  portion  of  food  without  nitrogen  is  absolutely  necessary  to  the  existence 
of  the  life  of  animals  merely  for  the  sake  of  forming  fat.  Wild  graminivorous 
animals  have  no  fat,  but  more  muscle  than  carnivorous;  they  become  fat  before 
the  breeding  seasons,  or  before  hybernation,  when  they  take  no  nourishment. 
This  inquiry  he  suras  up  in  the  following  terms: 

"Man  and  every  animal  are  exposed  at  every  period  of  their  lives  to  the 
unceasing  and  destructive  action  of  the  atmosphere;  with  every  breath  he  draws 
out  a  part  of  his  body;  every  moment  of  his  life  he  produces  carbonic  acid,  the 
carbon  of  which  his  food  must  replace. 

"If  we  observe  a  man  or  other  animal  in  sickness,  or  at  any  time  when  the 
body  is  not  supplied  with  nourishment  to  compensate  for  the  continual  loss,  we 
find  him  to  become  lean;  the  fat  is  the  first  to  disappear;  it  vanishes  through  the 
skin  and  lungs  in  the  form  of  carbonic  acid  and  water,  as  none  of  it  can  be 
found  in  the  faeces  or  urine.  Fat  resists  the  action  of  the  atmosphere  on  the 
body,  and  is  a  protection  to  the  organs.  But  the  action  of  the  atmosphere  does 
not  end  with  the  loss  of  the  fat.  Every  soluble  substance  in  the  body  gives  up 
its  carbon,  until  at  length  all  resistance  ceases,  and  death  and  decay  begin,  when 
every  part  of  the  body  enters  into  combination  with  the  oxygen  of  the  air.  The 
influence  of  the  atmosphere  is  the  cause  of  death  in  most  chronic  diseases;  from 
want  of  carbon  to  resist  its  action  that  of  the  brain  and  nerves  is  used.  In  a 
normal  state  of  health  and  nutrition,  however,  the  carbon  of  the  carbonic  acid 


504  Progress  of  the  Medical  Sciences,  [Oct. 

must  have  another  source,"  and  M.  Liebig  concludes  this  most  interesting  paper 
by  promising  another,  in  which  he  will  "endeavour  to  show  that  the  carbon  of 
such  substances  as  sugar,  gum,  and  starch  is  used  for  the  purposes  of  respira- 
tion and  the  production  of  animal  heat;  and  that  the  latter  is  closely  connected 
with  the  carbon  of  the  food." — Ed.  Med.  and  Surg.  Journ.  July,  1842,  from 
Annalen  der  Chimie  und  Pharm.  Aug.  1841. 

82.  Composition  of  animal  Substances. — M.  Bouchardat  read  a  memoir  to  the 
Academy  of  Sciences,  Paris,  June  20th,  1842,  on  the  immediate  composition  of 
fibrine,  gluten,  albumine,  and  caseum.  The  chief  conclusions  derived  by  the 
author  are — first,  fibrine  is  composed  of  four  immediate  principles,  in  variable 
proportions — viz.,  of  a  matter  identical  with  pure  albumine,  which  the  author 
proposes  to  call  albuminose;  this  matter  is  enclosed  in  the  meshes  of  a  'issue 
composed  of  gelatine  and  of  a  principle  exactly  similar  in  properties  to  the  epi- 
dermis, which  the  author  names  epidermose.  Here,  then,  we  find  in  the  blood 
two  fundamental  principles  of  animal  tissues— gelatine  and  epidermose — the  ex- 
istence of  which  in  the  vital  fluid  was  not  before  known. 

Secondly,  The  basis  of  albumen  in  the  eg^.,  of  serum  in  the  blood,  of  gluten 
in  vegetables,  and  of  caseum  in  milk  is  identical,  unless  we  admit  what  is  out 
of  the  question,  that  water  scarcely  reddening  turnsol  paper  possesses  sufficient 
chemical  power  to  transform  all  these  substances,  at  an  ordinary  temperature, 
into  one  and  the  same  principle. 

M.  Dumas  has,  also,  performed  some  recent  experiments  with  the  same  re- 
sults.    His  experiments,  made  in  conjunction  with  M.  Cahours,  prove — 

First,  That  the  albumen  of  serum,  eggs,  and  vegetables,  is  identical  in  com- 
position. 

Secondly,  That  caseum,  whether  taken  from  milk  or  plants,  has  the  same 
composition  as  albumen. 

Thirdly,  That  fibrine,  derived  from  the  blood  or  from  plants,  always  contains 
more  nitrogen  and  less  carbon  than  albumen  or  caseum. 

Fourthly,  That  almonds,  peas,  beans,  &c.,  contain  a  principle  something  ana- 
logous to  caseum,  but  furnishing  less  carbon  and  more  nitrogen  than  fibrine. 

Finally,  When  fibrine  has  been  deprived  of  all  its  soluble  matter  by  boiling 
water,  it  deposits  a  residuum  identical  in  composition  with  albumen  and  caseum; 
a  fact  well  explained  by  the  recent  researches  of  M.  Bouchardat. — Frov.  Med. 
Journ.,  July  2,  1842. 

83.  Analysis  of  the  menstrual  Fluid. — M.  Bouchardat  undertook  a  new  analy- 
sis of  the  menstrual  fluid,  obtained  from  a  female,  who  consented  to  allow  a 
speculum  to  remain  in  her  vagina  for  ten  hours,  in  order  that  an  ounce  of  it 
might  be  procured.  Without  this  precaution  the  fluid  becomes  mixed  with  vaginal 
mucus  and  urine,  as  the  presence  of  ammoniaco-magnesian  phosphate  proves.  The 
following  is  the  analysis:  water,  90.8;  fixed  matters,  6.92.  The  fixed  matters  were 
thus  composed;  fibrine,  albumen,  and  colouring  matter,  75.27;  extractive  matter, 
0.42;  fatty  matter,  2.21;  salts,  5.31;  mucus,  16.79.  The  female  from  whom  the 
secretion  was  obtained  was  a  patient  of  M.  de  Boismont,  and  he  considers  the 
great  proportion  of  water  due  to  the  delicacy  of  her  frame,  and  her  subsisting 
chiefly  on  a  vegetable  diet.  Another  specimen  of  menstrual  fluid,  examined  by 
M.  Donne,  gave  the  following  microscopic  characters:  1st,  abundance  of  the 
ordinary  globules  of  the  blood;  2nd,  vaginal  mucus  formed  of  epidermic  squamae 
from  the  mucous  membrane  of  the  vagina;  3d,  mucous  globules  furnished 
by  the  neck  of  the  uterus.  From  these  examinations  it  results  that  the  menstrual 
fluid  does  not  differ  from  arterial  blood.  As  to  the  acid  or  alkaline  nature  of 
the  fluid,  observed  by  authors,  it  depends  upon  the  presence  of  mucus  from  the 
vagina  and  neck  of  the  uterus.  This  mucus,  as  M.  Nauche  has  proved,  is  acid 
in  a  healthy  woman  and  after  delivery,  but  becomes  alkaline  when  it  is  glairous, 
or  the  product  of  inflammation;  if  only  a  limited  portion  of  the  passage  be  af- 
fected, the  secretion  will  be  acid  in  one  part  and  alkaline  in  another. — Frov.  Med. 
Journ.  July  30,  1842,  from  Boismont  on  Menstruation. 


1842,}  Miscellaneous.  505 


MISCELLANEOUS. 

84.  Hnmosapathy. — The  following-  announcement  appeared  in  V Examinateur 
Medical  of  the  9th  January  last,  and  has  been  copied  into  other  journals. 

"  By  a  decree  of  October  1841,  the  Emperor  of  Austria  has  created  a  chair  of 
homoeopathy  in  the  faculty  of  Vienna;  named  MM.  Worm  and  Nerbar  professors, 
and  appropriated  100  beds  in  the  St.  Elizabeth  Hospital  for  the  homoeopathic 
treatment  of  diseases,  under  the  superintendence  of  Dr.  Levy." 

This  decree,  it  seems,  has  the  same  foundation  as  the  report  so  industriously 
circulated,  that  M.  Breschet  had  become  a  convert  to  the  infinitesimal  humbug, 
and  is  one  of  the  innumerable  fictions  devised  by  that  industrious  and  inventive 
class  of  practitioners  to  increase  the  number  of  their  dupes. 

Dr.  Sigmund,  a  very  distinguished  physician  of  Vienna,  who  was  recently 
sent  by  his  government  to  France  to  study  the  organization  of  the  medical  pro- 
fession in  that  country,  on  seeing  the  above  statement  in  1' Examinateur  Medi- 
cal, addressed  to  the  respectable  editors  of  that  journal  a  letter,  the  following 
extract  from  which  they  have  published  in  their  No.  for  10th  April. 

"In  the  2d  No.  of  I'Examinateur  for  1842,  I  find  a  statement  which  is 
entirely  erroneous;  it  has  never  been  proposed  to  create  a  chair  of  homoeopathy 
in  the  faculty  of  Vienna;  the  government  have  neither  enacted  an  order  or  decree 
to  create  a  clinic  of  this  kind.  The  hospital  mentioned,  is  one  closed  to  students 
and  strangers;  a  distinct  foundation,  served  by  the  sisters  of  St.  Elizabeth,  and  the 
physician  of  which  is  one  of  our  brethren,  Dr.  Weninger,  who  has  never  prac- 
tised homoeopathy.  MM.  Worm,  Nerbar  and  Levy  are  entirely  unknown  in 
Vienna." 

85.  Destruction  of  the  Medical  Library  at  Hamburgh  in  the  recent  conflagration. 
— The  Medical  Union  of  Hamburg  has  sustained  a  most  severe  loss,  in  the  en- 
tire destruction  of  its  large  and  valuable  Library. 

We  invite  the  attention  of  authors  of  Medical  works  and  editors  of  Medical 
Journals  to  the  following  circular: 

"The  frightful  conflagration  which  visited  Hamburg  in  the  beginning  of  last 
May  has  not  spared  the  premises  of  the  Medical  Union,  whose  library,  the  fruit 
of  twenty-six  years'  assiduous  collection,  exists  no  more!  Such  a  loss  cannot 
be  repaired  by  pecuniary  contributions.  Complete  series  of  a  great  number  of 
German,  French,  English,  American,  and  Indian  Journals  and  works,  rare  editions 
of  the  older  authors,  a  multitude  of  ancient  and  modern  medical,  and  chirurgical 
encyclopaedias  and  lexicons  in  various  languages,  scarce  and  curious  prints,  &c., 
are  not  only  lost,  but  are  no  longer  procurable  by  purchase;  while  many  hundred 
volumes  of  old  dissertations,  classified  according  to  subjects,  cannot  be  replaced 
in  any  manner.  In  this  strait  the  Medical  Union  earnestly  requests  advice,  not 
only  from  its  foreign  members,  but  from  all  its  medical  brethren,  where  and  in 
what  manner  it  may  once  more  gradually  acquire  possession  of  a  library  at  the 
least  possible  expenditure  of  money.  Any  communication  on  this  subject,  in 
post  paid  letters  or  through  the  medium  of  the  booksellers,  addressed  to  'The 
Directors  of  the  Hamburg  Medical  Union,'  or  to  the  undersigned,  will  be  re- 
ceived with  the  sincerest  thanks.  The  Editors  of  Medical  Journals  are  request- 
ed kindly  to  give  insertion  of  this  notice  in  their  respective  publications. 

"F.  W^  OPPENHEIM,  M.  D." 

''Hamburg,  May  16,  1842." 

86.  Vaudeville  enacted  in  a  Lunatic  Asylum. — On  the  20th  of  July,  a  vaudeville 
was  performed  at  Bicetre  by  the  patients,  and  followed  by  a  musical  concert. 
The  actors  and  musicians  were  trained  by  ?iyo\mg  artiste^  M.  Florimond  Rouger, 
who  has  devoted  his  services  for  some  time  past  to  the  establishment.  The  play 
went  off  admirably,  and  the  most  perfect  harmony  reigned  throughout  the  proceed- 
ings.— Lancet,  Aug.  13,  1842. 

No.  VHI.— October,  1842.  43 


506  Progress  of  the  Medical  Sciences,  [Oct. 

87.  Revivification  of  Microscopic  Animalculse.. — M.  Milne  Edwards  read  a  re- 
port on  a  memoir  of  M.  Doyere  on  this  subject. 

It  is  well  known  that  when  a  few  drops  of  water  are  sprinkled  on  moss  which 
has  been  kept  dry  for  months  or  years,  certain  microscopic  animalculas  make 
their  appearance;  but  it  has  not  been  decided  whether  these  little  animals  are 
really  brought  to  life  again,  or  whether  their  ova  had  not  remained  concealed  in 
the  moss,  and  were  afterwards  vivified. 

M.  Doyere  has  found  that,  with  the  assistance  of  the  microscope,  we  can  dis- 
cover in  the  dried  sand  of  rain-spouts  a  number  of  small  bodies,  which  closely 
resemble  the  remains  of  these  animalcule,  deformed  through  the  effects  of  desic- 
cation. The  author  has  taken  these  remains,  carefully  dried  them  on  glass 
plates,  and  found  that  they  were  afterwards  capable  of  being  restored  to  life. 
On  pushing  his  experiments  further,  the  author  found  that,  on  applying  heat  at 
145°  or  150°  Fahrenheit,  the  animalculag  were  destroyed,  and  it  was  impossible 
to  bring  them  to  life  again.  But  when  they  were  previously  dried,  and  all  the 
moisture  which  they  naturally  contain  was  gradually  expelled,  they  resisted  a 
very  great  degree  of  heat;  in  some  experiments  the  heat  was  carried  to  120°  C, 
and  the  animalcuiae  afterwards  restored  to  life. — Frov.  Med,  Journ.,  Aug.  27, 1842. 

88.  Heallh  of  Paris. — It  appears  from  an  interesting  article  in  the  "  Gazette 
Medicale"  (August  Gth),  that  there  have  been  more  cases  of  sickness  than 
nsual  admitted  into  the  Paris  hospitals  during  the  present  year.  In  the  first 
five  months  33,045  cases  (not  38,175  as  is  assumed  by  our  contemporary  in 
calculating  the  mortality)  were  treated,  and  3189  persons  died;  the  deaths  in  the 
corresponding  months  of  1841  were  3087.  Small-pox  has  destroyed  great  num- 
bers; and  patients  have  more  than  once  contracted  this  disease  in  the  hospitals 
from  small-pox  patients  in  their  vicinity.  The  writer  in  the  "  Gazette"  asks  if 
no  step  can  be  taken  to  remedy  this  evil,  or  to  arrest  the  ravages  of  small-pox? 
The  epidemic,  he  remarks,  which  has  prevailed  during  two  years  in  England, 
has  completely  ceased  in  London,  the  registrar-general's  report  not  recording 
more  than  four  or  five  deaths  a"week  from  small-pox. 

Typhus  has  prevailed  in  Paris  for  the  last  six  weeks  or  two  months  with  an 
intensity  equal  to,  if  not  surpassing,  that  of  the  epidemic  of  1831.  It  is  not 
only  very  common  among  the  poor  v/ho  go  to  hospitals,  but  in  the  private  houses 
of  the  middle  classes.  Several  of  the  wards  of  the  hospitals  are  crowded.  In 
the  ordinary  Paris  fever  the  taches  lenticulares  are  rarely  observed;  this  year  they 
are  of  frequent  occurrence.  The  inflammatory  type,  not  very  well  marked, 
mingled  with  biliary  and  adynamic  phenomena,  predominates.  Tire  cases  are 
said  not  to  be  so  fatal  as  usual. — Lancet^  Aug.  20,  1842. 

89.  Health  of  London. — The  deaths  recently  registered  in  the  metropolis  are 
slightly  above  the  average.  In  the  two  weeks  ending  August  6,  the  numbers 
were  883,  890;  in  the  three  weeks  ending  July  23,  the  numbers  were  745,  785, 
744.  The  increase  has  been  considerable  in  diarrhcea^  dysentery^  and  cholera; 
from  which  the  numbers  registered  were  in  the  three  weeks  ending — 

.Tuly  16.  Aug.  6. 

Diarrhcea, 32 76 

Dysentery,  -----       4 19 

Cholera, 4 14 

40  109 

Children  and  aged  persons  have  been  the  greater  sufferers,  hut  persons  be- 
tween the  ages  of  15  and  60  have  not  escaped.  A  similar  increase  in  the  mor- 
tality took  place  last  year  in  September.  At  present  we  see  nothing  very 
alarming.  The  prevailing  diseases  may  be  fairly  ascribed  to  the  action  of  the 
temperature.  Typhus  fever  is  not  epidemic:  at  the  same  time  we  do  not  hesi- 
tate to  say  that  a  hundred  persons  are  now  killed  weekly  by  the  filth  and  open 


1842.] 


Miscellaneous.  507 


drains  in  and  about  London;  and  nnless  energ^etic  steps  be  taken  for  remedying 
this  state  of  things,  we  may  anticipate  a  visitation  eitlier  of  epidemic  typhus, 
influenza,  or  cholera. — Ibid. 

90.  London  Schooh. — Nearly  all  the  private  schools  in  London  have  been 
closed.  The  only  ones  remaining  are,  the  Aldersgate  Street  School,  and  the 
school  adjoining  St.  George's  Hospital.  The  once  celebrated  school  of  Mr. 
Granger  is  defunct. — Prov.  Med.  and  Surg.  Journ.,  Aug.  27,  1842. 

9L  University  of  Edinburgh. — Dr.  Home  has  resigned  the  chair  of  Practice  of 
Medicine,  and  Dr.  Alison  has  been  appointed  his  successor. 

Dr.  Henderson  has  been  appointed  to  the  chair  of  Pathology,  vacant  by  the 
resignation  of  Dr.  John  Thomson. 

Mr.  James  Miller  has  been  elected  Professor  of  Surgery  in  this  school,  in 
place  of  the  late  Sir  Charles  Bell. 

92.  Medical  Faculty  of  Paris. — M.  A.  Berard  has  been  elected  Professor  of 
Clinical  Surgery,  in  the  place  of  the  late  M.  Sanson. 

93.  Honours  to  Medical  Men. — M.  Cruveilhier,  Professor  of  the  Faculty  of 
Medicine,  and  M.  Begin,  principal  surgeon  of  the  Val  de  Grace,  have  been  nomi- 
nated officers  of  the  Legion  of  Honour,  of  France. 

94.  Obituary  Record. — We  regret  to  announce  the  death  of  the  veteran  Baron 
Larrey,  the  Nestor  of  French  military  surgery  [^at  the  advanced  age  of  seventy- 
six  years].  He  expired  on  Monday,  the  25th  ult.,  at  Lyons,  in  the  arms  of  his 
son,  who  had  accompanied  him  on  his  recent  visit  to  Africa,  to  inspect  the  troops 
there,  whence  he  had  just  returned.  His  professional  life  commenced  in  1787, 
when  he  embarked  for  America  as  surgeon-major  in  the  royal  navy.  He  was 
afterwards  attached  to  Napoleon's  army,  where  he  was  highly  esteemed.  By 
that  great  general,  whom  he  followed  in  all  his  campaigns,  he  was  spoken 
of  as  a  "  most  honest  man."  The  Baron's  skill  as  a  practical  surgeon  is 
attested  by  his  great  work  on  military  surgery,  which  contains  the  results  of 
his  long  experience  gained  by  constant  practice  in  the  most  sanguinary 
wars  that  have  ever  devastated  Europe.  It  is  remarkably  free  from  national 
prejudice,  and  abounds  with  interesting  fricts  and  useful  observations,  it,  in 
addition,  recommends  itself  to  the  general  reader  and  historian  as  well  as  to  the 
medical  man,  inasmuch  as  it  contains  an  excellent  sketch  of  his  great  master's 
victories  and  campaigns,  graphically  and  philosophically  drawn,  and  also  fur- 
nishes information  with  respect  to  the  internal  arrangements  of  the  army,  for 
which  the  world  was  not  prepared.  It  will  scarcely  be  believed,  that  when 
Napoleon  assembled  that  immense  army  of  400,000  men,  tor  the  subjugation  of 
the  Russian  empire,  little  or  no  preparation  was  made  for  the  relief  of  the 
wounded.  Yet  such  was  the  fact.  Larrey  says,  when  describing  the  battle  of 
Smolenski,  "  Here,  as  at  Witepsk,  we  were  in  want  of  all  sorts  of  things  neces- 
sary for  dressing  the  wounded.  For  lint  we  were  obliged  to  substitute  paper, 
and  the  parchment  archives  of  the  city  were  converted  into  splints."  An  excel- 
lent occasion  certainly  to  bring  forth  the  talent  and  ready  zeal  of  the  head  of  the 
surgical  department,  but  one  that  will  in  no  way  increase  the  lustre  of  Napo- 
leon's name.  He  evidently  thought  only  of  victory,  and  was  unprepared  for 
defeat,  and  even  for  the  inevitable  consequences  of  success. 

Larrey  was  with  the  troops  throughout  their  advance,  and  accompanied  them 
also  in  their  disastrous  retreat.  He  attributed  his  preservation  during  the  return. 
to  his  habit  of  marching  on  foot.  He  walked  almost  the  whole  way,  and  nev«^r 
approached  a  fire.  Those  who  did  not  observe  this  precaution  were  so  be- 
numbed by  the  cold,  that  when  the  bivouac  fires  were  lighted,  they  did  not  feel 
the  heat  till  the  seeds  of  gangrene  were  sown.  The  intense  cold  was  their  prin- 
cipal enemy. 


508  Progress  of  the  Medical  Sciences.  [Oct. 

At  the  fatal  passage  of  the  Beresina,  Larrey  nearly  lost  his  life,  owing  to  his 
anxiety  to  preserve  his  surgical  instruments,  but  the  attachment  of  the  soldiers 
saved  him,  for  he  vs^as  no  sooner  recognised  in  the  crowd,  than  he  was  raised 
over  the  heads  of  the  troops,  and  passed  forward  from  man  to  man  until  he 
reached  the  bridge,  then  blocked-up  with  military  materials  and  the  bodies  of 
the  dead  and  dying. 

Larrey,  on  his  return,  continued  employed  in  a  military  capacity,  and,  at  the 
time  of  his  death,  he  held  the  rank  of  Inspecteur  du  Conseil  de  Sante  des  Ar- 
mees.  He  has  enriched  medical  science  with  many  valuable  observations, 
drawn  from  the  experience  of  a  long  and  active  life — peace  be  to  his  manes. — 
Prov.  Med.  Journ.,  Aug.  6,  1842. 

Died  suddenly,  June  13th,  of  pulmonary  apoplexy,  at  the  age  of  67  years, 
M.  Double,  one  of  the  most  useful  and  respectable  members  of  the  French 
Academy  of  Sciences. 

Pellatier,  the  distinguished  chemist  and  professor  in  the  School  of  Phar- 
macy, died  in  Paris,  in  July  last,  after  a  long  and  painful  illness.  He  rendered 
great  service  to  science  by  his  researches,  in  association  with  M.  Caventou,  on 
the  vegetable  alkalies. 

95.  JVew  French  Medical  Works. — Our  recent  Journals  announce  the  publica- 
tion of  the  following  works: — 

De  L'lrrigation  dans  les  Maladies  Chirurgicales;  these  du  concours  pour  la 
chaire  de  pathologie  chirurgicale;  par  M,  Malgaigne,  in  8vo.     Prix  2  fr.  50  c. 

Histoire  de  la  Ohirurgie,  par  Peyrilhe  et  Eujardin.     2  vols,  in  4to. 

Recherches  Anatomiques,  Pathologiques  et  Therapeutiques  sur  les  Maladies 
des  organes  urinaires  et  genetaux,  considerees  speciaiement  chez  les  hommes 
ages;  ouvrage  entierement  fonde  sur  des  Nouvelles  Observations;  par  le  Doct. 
Auguste  Mercier.     1  vol.  in  8vo.  Prix  6  fr. 

Essai  sur  le  Traitement  Rationnel  de  la  descente  de  I'uterus  et  les  Affections 
les  plus  communes  de  cet  organe,  lu  le  9  Sept.  1838,  a  la  Soc.  de  Med.  d'An- 
gers,  par  le  Doct.  C.  Ollivier  d'Angers.    1  vol.  in  8vo.,  de  128  pages,  Prix.  2  fr. 

Quels  sont  les  cas  oii  Ton  doit  preferer  lalithotomie  a  la  lithotritie,  these  pre- 
sentee au  concours  pour  la  chaire  de  clinique,  chirurgicale,  vacante  a  la  Faculte 
de  Medecine  de  Paris;  par  le  Doct.  A.  Thierry,  Prix  2  fr.  50  c. 

Des  anevrismes  de  la  region  sus-claviculaire  (these  de  concours);  par  A.  Ro- 
bert, 8vo.  p.  134,  pi.  1.     Prix  3  fr. 

Diagnostic  differential  des  tumeursdu  sein  (these  de  concours);  par  A.  Berard, 
8vo.  p.  180.     Prix  3  fr.  50  c. 

Nouvelle  Dermatologie,  ou  Precis  theorique  et  pratique  sur  les  maladies  de  la 
peau  fonde  sur  une  nouvelle  classification  medicale,  suivi  d'un  expose  des  prin- 
cipes  generaux  pouvant  servir  de  guide  dans  le  choix  des  eaux  minerales  natu- 
relles  applicables  dans  le  traitement  de  ces  maladies,  avec  un  formulaire  special 
et  planches  coloriees;  par  P.  Baumes,  chirurgien  en  chef  de  I'hospice  de  I'Anti- 
quaille  de  Lyon,  membre  correspondant  de  I'Academie  royale  de  medecine  de 
Paris,  etc.,  2  vols,  in  8 vo.     Prix  16  fr. 

Museum  d'Anatomie  Pathologique  de  la  Faculte  de  Medecine  de  Paris,  ou 
Musee  Dupuytren  public,  au  nom  de  la  Faculte.  2  vols,  in  8vo,  un  atlas  de  plan- 
ches in  folio.    Prix  14  fr.     Paris. 


1842.]  509 


AMERICAN    INTELLIGENCE, 


Mania  from  Decayed  Teeth.  By  Dr.  Wm.  Mendenhall,  of  Beverly, 
of  Anson  Co.,  N.  C. — A  black  boy,  about  12  or  14  years  of  age,  was  at- 
tacked with  mania  in  the  month  of  May  1840,  supposed  to  have  arisen  from 
overheating  in  trying  to  subdue  a  fire  which  broke  out  upon  his  owner's 
fencing.  Cathartics,  blistering,  cupping  and  venesection,  with  many  other 
remedies,  were  tried,  which  relieved  him,  in  some  measure,  during  the 
greater  part  of  the  year  1841.  But  in  .January,  1842,  he  became  quite  a 
maniac  again,  and  so  continued,  notwithstanding  all  the  above  remedies  were 
used,  together  with  shaving  the  head  and  the  application  of  cold  water,  and 
opening  the  temporal  artery,  and  taking  considerable  blood.  A  few  weeks 
ago  it  was  discovered  that  he  had  two  decayed  teeth  in  the  upper  jaw,  one 
on  the  right,  the  canine  tooth,  the  other  on  the  left,  one  of  the  anterior  molars, 
both  of  which  were  extracted,  since  which  time  lie  has  been  quite  restored. 
The  day  before  the  extraction  he  escaped  from  the  family,  and  passed  the 
night  in  the  woods,  and  was  caught  in  the  act  of  running  away,  after  com- 
ing near  or  to  the  house  in  the  absence  of  the  family.  Since  that  time  he 
has  regularly  attended  to  business  without  showmg  any  marks  of  insanity. 

Excision  of  the  upper  Maxillary  Bone.  By  R.  D.  Mussey,  M.  D.  &c. — 
Thomas  McGillighan,  a  locksmith,  aet.  22,  consulted  me,  in  July,  1839,  for  a 
painful  affection  of  the  left  side  of  the  face,  which  had  existed  about  eight 
months.  The  left  nostril  was  entirely  blocked  up  by  an  adventitious  growth  of 
considerable  firmness,  which  extended  anteriorly  within  half  an  inch  of  the 
margin  of  the  ala  and  septum,  and  posteriorly  so  far  as  to  be  felt  by  the  finger 
above  the  floating  edge  of  the  soft  palate.  The  ceiling  of  the  mouth,  on  the  left 
side,  was  pushed  downwards,  so  as  to  present  a  slight  convexity,  and  the  cheek 
was  more  prominent  than  the  other.  For  the  pain  which  extended  along  the 
alveolar  arch,  he  had  several  teeth  extracted,  but  without  any  important  relief. 
The  general  health  was  not  materially  affected.  As  there  could  be  no  doubt 
that  the  tumour  sprung  from  the  antrum,  and  as  its  progress  had  been  somewhat 
rapid,  I  recommended  the  excision  of  the  jaw-bone,  as  soon  as  the  hot  weather 
should  subside,  and  a  strict  adherence  to  farinaceous  diet,  with  water  and  a 
small  quantity  of  milk  for  drink,  which  course  was  faithfully  pursued. 

On  the  28th  of  September,  1839,  I  performed  the  operation  in  the  following 
manner. — An  incision  through  the  integuments,  commencing  a  quarter  of  an 
inch  below  the  tendon  of  the  orbicularis  palpebarum,  was  carried  down  by  the 
side  of  the  nose,  and  close  to  the  convex  border  of  the  ala,  thence  horizontally 
to  the  median  line,  from  which  point  the  upper  lip  was  cut  throuc^h  vertically. 
Another  curvilinear  incision  extended  from  the  angle  of  the  mouth  to  the  outer 
margin  of  the  bony  orbit  as  high  as  the  external  canthus.  The  flap  included 
between  these  incisions  was  dissected  up  and  thrown  upon  the  forehead,  and  the 
malar  bone  was  exposed  by  a  horizontal  incision  of  an  inch  backv/ard  along  the 
zygoma  from  the  margin  of  the  second  incision.  An  incision  on  the  median 
line  from  the  incisors  to  the  posterior  edge  of  the  hard  palate,  through  the  lining 
of  the  arch  of  the  mouth,  and  another  through  that  of  the  palate,  separating  it 
from  the  palate  plate  of  the  palate  bone,  completed  the  section  of  the  soft 
parts.    By  the  aid  of  a  saw  and  bone  nippers  the  bony  connections  were  divided, 

43* 


510  American  Intelligence.  [Oct. 

and  the  whole  of  the  upper  maxillary  bone,  except  the  point  of  its  nasal  pro- 
cess—which was  left  on  account  of  the  lachrymal  sac — was  removed,  together 
with  a  part  of  the  malar,  and  the  whole  of  the  palate  plate  of  the  palate  bone. 
The  tumour  occupied  the  cavity  of  the  antrum,  had  pushed  through  its  anterior 
wall,  and  attenuated  its  flooring,  filled  up  the  whole  nasal  avenue,  pressed  the 
septum  some  way  into  the  right  nostril,  and  crowded  itself  into  the  cells  of  the 
sphenoid  bone,  and,  if  I  judge  correctly,  filled  up  the  whole  cavity  of  the  body 
of  that  bone.     From  this  situation  I  dug  it  out  with  the  point  of  my  finger. 

There  was  not  much  hemorrhage.  Three  or  four  vessels  only  required  the 
ligature.  The  flaps  were  preserved  in  situ  by  stiches,  and  a  great  part  of  the 
wound  united  by  adhesion.  No  severe  pain  nor  considerable  constitutional  irri- 
tation followed  the  operation,  and  on  the  tenth  day  the  patient  took  a  walk  in 
the  street.  The  tumour  was  firm  and  somewhat  fibrous  in  some  parts,  and  de- 
cidedly encephaloid  in  others.  From  its  soft  and  homogeneous  texture,  I  enter- 
tained fears  that  it  might  return,  and  enjoined  it  upon  the  patient  to  live  without 
flesh,  fish  or  greasy  food,  with  no  condiment  except  salt,  and  to  drink  nothing 
but  water — a  course  which  he  has  rigidly  followed  to  the  present  time.  He  has 
enjoyed  fine  health,  without  a  trace  of  the  disease,  since  the  operation— a  period 
of  two  years  and  nine  months.  The  winter  after  the  operation.  Dr.  Cook,  an 
ingenious  dentist  of  our  city,  inserted  a  gold  palate,  with  an  arch  of  teeth, 
which  restored  a  natural  appearance  to  the  mouth,  and  a  perfect  articulation. 
This  is  still  worn,  and  so  slight  a  deviation  from  symmetry  between  the  two 
sides  of  the  face  exists  that  very  few  would  suspect  any  operation  to  have  been 
performed  upon  it. 

Mr.  McGillighan  is  now  a  thriving  mechanic,  and  a  worthy  citizen. — Western 
Lancet^  Kug.  1842. 

Ununited  Fracture  nf  the  Fore-arm^  of  four  years'^  standing. — Dr.  Chas.  S. 
Tripler,  U.  S.  Army,  relates  in  the  Maryland  Med.  and  Surg.  Journ.,  Sept. 
1842,  a  case  of  this  kind  successfully  treated  by  him.  The  subject  of  the  case 
was  a  Lieutenant  in  the  army,  30  years  of  age,  of  scrofulous  habit,  who  broke 
both  bones  of  his  left  fore-arm,  four  years  ago.  Upon  examination  30th  Jan.  1 842, 
"it  appeared  that  the  radius  was  broken  within  two  inches  of  its  humeral  ex- 
tremity, and  the  ulna  at  one-third  of  its  length  from  the  elbow.  The  radius  was 
not  much  displaced,  but  there  was  a  prominence  at  the  fractured  point,  as  if  the 
superior  portion  were  depressed  and  thrust  under  the  lower  portion.  The  frac- 
tured extremities  of  the  ulna  were  displaced  toward  the  ulnar  edge  and  back  of 
the  radius,  forminor  a  large  and  salient  angle  at  the  point  of  meeting.  By  exten- 
sion the  bone  could  be  brought  nearly  into  its  normal  position  and  plane.  The 
limb  was  useless  except  in  lifting  weights  in  the  direction  of  its  axis.  The 
moment  the  elbow  joint  was  flexed,  the  hand  became  powerless.  The  fore-arm 
was  shortened  nearly  three  inches." 

The  false  joint  in  the  ulna  admitting  of  the  greater  degree  of  motion,  Dr.  T. 
thought  it  probable,  that  if  he  could  effect  an  osseous  union  in  that  bone,  the  use 
of  the  arm  would  be  sufl&ciently  restored  for  all  ordinary  purposes.  With  this 
view  he  determined  to  try  pressure  as  recommended  by  Brodie,  Amesbury  and 
others. — He  placed  a  flat,  broad  splint  upon  the  palmar  face  of  the  fore-arm,  and 
a  firm  oval  pad  over  the  fractured  point  of  the  bone.  A  roller  was  then  nicely 
adjusted  from  the  fingers  to  the  elbow,  over  the  pad,  while  extension  of  the  limb 
was  made  by  an  assistant.  Additional  pressure  was  made  upon  the  pad,  by 
means  of  an  iron  band  passing  round  the  arm  with  a  thumb-screw  working 
through  it.  It  required  some  further  contrivance  to  adjust  this  band  and  screw, 
so  as  to  bring  the  force  in  a  direction  perpendicular  to  the  axis  of  the  ulna. 

The  pain  caused  by  this  apparatus  was  excessive.  The  patient  declared  he 
could  not  bear  it,  and  day  after  day,  during  the  surgeon's  absence  removed  it, 
and  after  some  relief  was  experienced  clumsily  reapplied  it  himself.  Dr.  T. 
persevered  in  the  use  of  the  apparatus  for  eleven  weeks,  when  firm  union  was 
found  to  have  been  accomplished  in  the  ulna. 

"It  was  novv'  discovered  that  the  mobility  of  the  false  joint  in  the  radius  was 


1842.] 


American  Intellis!:ence.  511 


such  as  still  to  impede,  in  an  important  degree,  the  functions  of  the  org'an.  The 
pronator  and  supinator  muscles  being  inserted  into  that  bone,  rotation  was  of 
course  very  imperfect,  and  the  flexibility  of  the  fore-arm  at  the  point  of  fracture 
of  the  radius  would  hinder  the  complete  ossification  of  the  ulna.  It  became 
necessary  then  by  some  means  to  endeavour  to  produce  bony  union  in  the  radius. 
Pressure,  Dr.  T.  thought  too  tedious  and  uncertain,  nor  could  he  contrive  any 
satisfactory  mode  of  applying  it  to  this  bone,  under  the  particular  circumstances 
of  the  case.  The  same  reasons  forbade  the  use  of  the  seton.  He,  therefore, 
after  consultation  with  Dr.  Pitcher  determined  to  excise  the  ends  of  the  bone, 
and  performed  that  operation  on  the  18th  of  April,  "by  making  an  incision 
about  four  inches  long,  through  the  integuments  and  fascia  over  the  supinator 
longus  muscle,  dissecting  down  to  tlie  bone  carefully  on  the  outer  side  of  that 
muscle,  and  then  removing  tlie  fractured  extremities  of  the  radius  with  the  tre- 
phine. 

The  operation  was  rendered  painful  and  tedious,  by  the  difficulty  experienced 
in  detaching  the  pieces  of  the  bone  from  the  interosseous  ligament,  the  wound 
being  very  deep  and  narrow. 

The  edges  of  the  wound  were  brought  together  with  adhesive  straps,  and  the 
arm  secured  in  pasteboard  splints  and  a  roller.  The  next  day  there  was  some 
excitement,  and  the  arm  above  the  elbow  was  somewhat  red  and  tumefied;  on 
the  20th  this  inflammation  was  increased  and  had  assumed  distinctly,  the  form 
of  phlegmonous  erysipelas.  The  wound  looked  perfectly  well.  In  a  day  or 
two  the  diffuse  cellular  inflammation  suppurated,  with  the  usual  accompaniments, 
rigors,  burning  pains,  &c.,  and  vv^as  relieved  by  discharging  its  pus  partly  through 
the  wound  and  partly  through  a  counter  opening  above  the  elbow.  After  this  the 
patient  had  two  attacks  of  intermittent  fever  of  the  tertian  type,  both  of  them  re- 
producing the  swelling  and  suppuration  of  the  skin  and  cellular  tissue  above  the 
elbow,  and  retarding  the  cicatrization  of  the  wound  made  in  the  operation. 

By  constant  attention  to  the  general  health  of  the  patient,  union  was  effected. 
by  the  31st  of  May,  and  on  the  17th  of  June,  the  external  wound  was  completely 
cicatrised. 

The  arm  is  now  about  one  inch  shorter  than  the  other.  The  radius  is  per- 
fectly straight;  the  ulna  is  firmly  united  at  a  small  angle;  the  motions  of  pro- 
nation and  supination  are  performed  very  well  and  are  daily  increasing. 

Femoral  Aneurism — Ligature  of  the  External  Iliac — Death  on  the  fifth  day.  By 
W.  Power,  M.  D. — The  subject  of  this  case  was  a  stout  labourer,  aetat.  61. 
The  aneurismal  tumour  was  of  fifteen  months'  duration,  and  was  situated  in  the 
right  groin  immediately  below  Poupart's  ligament.  It  was  irregularly  rounded 
in  its  form,  measuring  three  and  a  half  by  three  inches.  Its  pulsation  was  evi- 
dent to  the  eye.  Compression  above  the  tumour  arrested  all  pulsation.  The 
artery  for  an  inch  above  the  tumour  felt  larger  than  that  of  the  opposite  side; 
the  glands  of  the  groin  were  swollen  and  hard;  the  leg  was  one-third  larger  than 
that  of  the  left  side,  of  a  purplish  colour,  one  degree  higher  in  temperature,  often 
affected  with  cramp,  and  pain  with  a  sense  of  numbness  over  the  knee  and 
instep.  Pulse  80;  sounds  of  the  heart  clear  and  distinct;  no  ossification  of  the 
arteries  at  the  wrist.     General  health  good. 

On  the  19th  of  July,  1842,  ligature  of  the  external  iliac  artery  was  performed 
in  the  method  recommended  by  Cooper  at  three  inches  above  Poupart's  ligament. 
All  pulsation  in  the  tumour  ceased  upon  tightening  the  ligature.  The  sides  of 
the  wound  were  brought  together  with  two  points  of  suture,  and  a  few  adhesive 
straps. 

On  the  following  day,  the  tumour  had  decreased  one-third  in  size,  was  hard 
on  its  external  side,  and  presented  slight  pulsation  at  its  inner  and  upper  portion. 

On  the  21st  the  abdomen  became  tympanitic  and  pain  occurred  in  the  loins 
and  right  iliac  region;  bladder  irritable;  pulse  140,  and  small. 

On  the  22d  and  23(1,  his  symptoms  were  all  better,  and  on  the  morning  of  the 
24th,  his  pulse  was  90  and  soft,  and  everything  portended  a  happy  result;  but 
at  one  o'clock,  immediately  after  awaking  from  a  sleep,  he  was  found  to  be  de- 


513  American  Intelligence.  [Oct. 

lug-ed  with  blood.  This  hemorrhage  ceased  spontaneously,  and  did  not  return. 
He  sunk  rapidly,  and  died  at  7  P.  M.,  it  not  being  deemed  advisable  to  make 
any  effort  to  secure  the  vessel,  as  it  was  judged  the  slightest  shock  would  have 
determined  dissolution  under  the  hands  of  the  operator. 

Upon  dissection,  the  peritonitis  which  had  existed  was  found  to  have  been 
local,  and  was  entirely  subdued.  The  artery  was  found  with  the  ligature  around 
it,  with  an  opening  immediately  under  the  knot.  The  two  external  iliac  arte- 
ries were  equal  in  size;  the  inner  coat  of  a  creamy  yellow  colour,  a  little  rough. 
On  the  posterior  half  of  the  artery,  the  inner  coat  had  not  been  cut  through  by 
the  ligature,  but  was  wrinkled  and  crimped  so  as  to  be  smoothed  out  with  some 
difficnlty;  there  was  no  effusion  of  lymph.  A  soft  clot  existed  below,  but  none 
above  the  ligature.  The  artery  for  an  inch  above  the  commencement  of  the 
tumour  was  filled  with  osseous  concretions  grating  under  the  scalpel. — Mary- 
land Med.  and  Surg.  Journ.^  September,  1842. 

Immovable  Apparatus. — Dr.  Geo.  Hayward,  in  an  interesting  report  of  surgi- 
cal cases  treated  in  the  Massachusetts  General  Hospital,  remarks  that  "  the  starch 
bandage,  or  immovable  apparatus,  as  it  is  called,  is  no  doubt  a  valuable  im- 
provement in  the  treatment  of  fractures.  In  many  cases  where  the  bones  of  the 
lower  extremity  are  broken,  it  does  away  with  the  necessity  of  confining  the 
patient  to  his  bed,  by  affording  a  steady,  uniform  and  firm  support  to  the  limb, 
and  thus  preventing,  in  a  great  measure,  the  danger  of  displacing  the  fractured 
ends  of  the  bone.  He  can  by  this  means  move  about  with  the  aid  of  canes  or 
crutches,  and  bear  some  degree  of  weight  on  the  injured  leg,  even  before  the 
provisional  callus  is  formed.  It  will  also  be  often  found  useful  in  fractures  of 
the  arm,  enabling  the  patient  to  walk  freely  about  his  ordinary  avocations,  not 
requiring  his  confinement  to  the  house  for  a  single  day. 

"  In  numerous  cases  it  has  been  applied  at  the  hospital  with  great  advantage, 
nor  am  1  aware  that  any  bad  effects  have  resulted  from  it  there  in  a  single 
instance.  But  it  must  be  admitted  that  its  injudicious  application  may  be  pro- 
ductive of  the  most  disastrous  consequences.  By  the  undue  pressure  which  is 
sometimes  made  by  it,  inflammation,  ulceration  and  gangrene  have  followed, 
that  have  cost  the  patient  his  limb,  if  not  his  life. 

"  I  should  not  regard  it  safe  to  apply  a  starch  bandage  immediately  after  the 
occurrence  of  a  fracture,  if  the  limb  were  swollen  at  the  time,  or  if  there  was 
reason  to  believe,  from  the  degree  of  injury,  that  swelling  was  likely  to  come 
on.  The  swelling  in  such  cases  may  arise  from  the  effusion  that  takes  place,  or 
from  the  inflammation  that  is  the  consequence  of  the  violence  that  has  been 
done  to  the  parts,  in  either  case,  mechanical  pressure  cannot  prevent  it;  and 
it  is  well  known  that  the  combined  action  of  pressure  and  inflammation  will 
cause  a  part  to  ulcerate,  and  if  it  be  continued,  sloughing  will  follow.  It  not 
unfrequently  happens  that  a  bone  is  broken  without  the  occurrence  of  any  swel- 
ling, the  force  which  caused  the  accident  having  been  applied  at  some  distance 
from  the  fracture.  In  such  cases  a  starch  bandage  can  be  early  applied  with 
safety;  it  is  only  necessary  to  wait  a  few  hours,  and  if  swelling  has  not  then 
begun,  longer  delay  will  not  be  required. 

"It  is  not  my  purpose  in  these  remarks  to  point  out  the  various  circumstances 
in  which  a  starch  bandage  may  be  useful;  my  sole  object  was  to  caution  those 
who  are  not  familiar  with  it,  against  its  indiscriminate  application." — New  Eng- 
land Quarterly  Journal^  July,  1842. 

Fracture  of  the  Patella.  By  Geo.  Hayward,  M.  D. — The  patient  was  67 
years  of  age,  in  tolerable  health,  though  feeble.  In  coming  down  stairs  he 
made  a  false  step,  and  the  fracture  was  the  consequence  of  the  violent  contrac- 
tion of  the  muscles.  It  was  transverse,  as  it  usually  is  when  produced  by  mus- 
cular action.  He  was  brought  to  the  hospital  sixteen  hours  after  the  accident; 
the  knee  was  much  swollen,  and  very  painful.  His  body  and  limb  were  put  in 
such  a  position  as  to  relax  the  muscles,  and  leeches  and  cold  applications  were 
applied  to  the  joint.     No  apparatus  was  used  till  six  days  after  the  accident;  at 


1842.] 


American  JnteUio^ence.  513 


that  time  the  swelling  and  pain  having  in  a  great  measure  subsided,  a  very  sim- 
ple one  was  employed.  The  limb  was  first  covered  with  a  roller  from  the  foot 
to  the  hip,  and  a  hollow  splint  was  then  applied  on  the  under  side,  extending 
from  the  nates  to  the  heel.  To  this  were  attached  two  rollers,  each  two  and  a 
half  yards  long,  six  inches  apart,  one  above  and  the  other  below,  and  these  car- 
ried above  and  below  the  joint  were  sufficient,  with  the  aid  of  compresses,  to 
keep  the  fragments  of  the  patella  in  apposition.  Union  took  place  in  five  weeks; 
passive  motion  was  then  gradually  given  to  the  joint,  so  that  in  two  weeks  more 
he  walked  with  ease,  and  could  bend  his  knee,  and  he  was  discharged  "  well." 
The  bone  was  united  here,  as  is  usual  in  such  cases,  by  ligament;  but  this  was 
so  short  that  there  was  no  lameness  or  inconvenience.  It  is  undoubtedly  true 
that  a  ligamentary  union  in  fractures  of  the  patella,  is  better  than  that  by  bone, 
provided  the  ligament  he  short,  as  it  is  stronger  and  less  liable  to  interfere  with 
the  motions  of  the  joint.  To  effect  union  in  these  cases,  a  simple  apparatus, 
with  a  proper  position  of  the  body  and  limb,  seems  to  be  all  that  is  required;  at 
any  rate,  it  is  more  likely  to  be  accomplished  in  this  way  than  in  any  other.  A 
starch  bandage  I  should  not  regard  as  safe  and  proper  in  fractures  of  the  patella; 
there  is  so  much  swelling  for  some  days,  that  ulceration,  if  not  sloughing,  will 
probably  follow  its  application  if  it  was  made  early,  and  either  of  these,  in  such 
a  situation,  would  be  of  a  very  serious  character. — Ibid. 

Enlargement  of  Bursa  over  Patella.  By  Geo.  Hayward,  M.  D. — Enlarge- 
ment of  the  bursa  over  the  patella  is  by  no  means  unfrequent.  I  have  seen 
more  cases  of  it  in  females  than  in  males.  It  sometimes  comes  on  spontane- 
ously; at  others,  it  is  the  effect  of  an  injury,  not  showing  itself,  however,  till 
some  days  after  the  injury  has  been  received,  and  is  then  discovered  at  first 
usually  by  accident;  and  again  it  is  thought  to  arise  very  often  in  consequence 
of  pressure.     Hence  it  is  frequently  called  in  England  the  housemaid's  knee. 

When  it  is  the  seat  of  active  inflammation,  as  it  sometimes  is,  red,  hot  and 
painful,  it  should  be  treated  by  leeches  and  cold  applications,  and  these  are  fre- 
quently sufficient  to  remove  it.  But  ordinarily  it  is  not  inflamed.  It  is  a  sim- 
ple, colourless  swelling,  without  pain,  and  is  inconvenient  only  from  its  size 
and  situation;  though  the  patient  olten  imagines  that  the  limb  of  that  side  is  not 
as  strong  as  the  other.  It  is  certainly  desirable  to  remove  it,  because  it  will 
continue  to  increase  in  size,  and  occasionally  I  have  known  it  to  take  on  a  low 
degree  of  inflammation,  which  terminated  in  ulceration,  leaving  an  irritable  sore 
that  was  very  difficult  to  heal. 

A  very  simple,  and  in  most  cases  I  have  found  it  an  effectual  mode  of  treat- 
ing these  enlarged  bursae,  is  to  puncture  them  so  as  to  drain  off  all  the  contents, 
and  then  apply  a  blister,  keeping  it  open  for  ten  or  twelve  days,  by  means  of 
savin  cerate,  or  some  other  irritating  mode  of  application.  But  when  the  swell- 
ing has  existed  for  a  long  time,  so  tiiat  the  cyst  has  become  much  thickened, 
and  its  contents  changed  in  character  and  consistence,  this  method  will  not 
always  succeed.  In  such  cases  the  tumour  should  be  punctured,  and  if  it  fills 
again,  as  it  usually  does,  it  should  be  laid  open  by  a  free  incision.  It  may  be 
necessary  to  insert  a  piece  of  lint  between  the  lips  of  the  wound  to  bring  on  the 
proper  degree  of  inflammation;  should  this,  however,  be  excessive,  a  poultice 
should  be  applied.  I  have  never  seen  a  case  where  it  was  requisite  to  remove 
the  sac,  though  it  is  said  that  occasionally  a  cure  cannot  be  effected  without  it. 

This  is  a  difficulty  that  cannot  be  safely  tampered  with;  it  is  best,  I  believe, 
in  all  cases  to  puncture  it  in  the  first  instance,  though  this  alone  is  rarely  suffi- 
cient to  effect  a  cure.  But  if  more  powerful  means  are  adopted  at  once,  a 
degree  of  inflammation  will  sometimes  come  on,  extending,  perhaps,  up  the 
whole  limb,  with  such  severe  constitutional  symptoms  as  to  render  it  trouble- 
some, if  not  alarming.  Nothing  serious  is  to  be  apprehended  from  a  simple 
puncture. 

Some  years  since  I  introduced  a  small  seton,  consisting  of  two  or  three 
threads  only,  through  an  enlarged  bursa  over  the  patella,  and  though  a  cure 
was  effected  by  it,  the  inflammation  was  so  great  that  I  have  never  been  templed 
to  repeat  the  practice. — Ibid. 


514  American  Intelligence.  [Oct. 

Opium  in  Strangulated  Hernia. — In  the  department  of  Surgery  in  the  quarter- 
ly summary  of  our  preceding-  No.,  p.  179,  we  have  noticed  the  efficacy  of  opium 
in  the  reduction  of  strangulated  hernia,  and  we  have  pleasure  in  adding-  the  fol- 
lowinor  cases,  related  by  Dr.  A.  B.  Shipman,  of  Cortlandville,  in  the  New  York 
Med.  Gaz.,  and  which  bear  testimony  to  the  same  effect. 

"Case  1.  On  the  6th  of  September,  1836,  I  received  an  urgent  summons  to 
Tuliy,  Onondatja,  Co.,  to  perforin  the  operation  of  strangulated  hernia.  The 
distance  being  16  miles,  I  did  not  arrive  there  until  midnight,  when  1  found  the 
patient  easy,  the  hernia  returned,  and  he  under  the  full  influence  of  opium.  His 
attending  physician,  Dr.  Van  Dusen,  informed  me  that  the  patient,  an  old  gen- 
tleman, by  the  name  of  White,  had  laboured  under  an  inguinal  hernia  of  large 
size  for  many  years;  it  had  often  been  strangulated,  but  had  been  reduced  with- 
out much  trouble  until  this  time. 

Early  on  the  morning  of  the  sixth.  Dr.  Van  Dusen  was  called  to  see  the  case, 
and  found  that  the  patient  had  been  in  pain  with  it  since  early  in  the  evening  pre- 
ceding, and  had  made  unavailing  efforts  to  replace  it.  The  tumour  was  large, 
hard,  and  exquisitely  painful  and  tender.  He  was  bled  to  faintness,  and  took  nau- 
seating doses  of  tart,  ant.;  cold  evaporating  lotions  were  applied,  and  the  taxis  per- 
severed in  until  the  tenderness  in  the  tumour  was  such  as  to  be  no  longer  endured. 
The  operation  then  appeared  the  only  remedy;  but  as  the  patient's  sufferings 
were  great,  the  doctor  gave  him  a  large  anodyne  of  sulph.  of  morphine,  and  sat 
down,  patiently  awaiting  my  arrival.  Four  hours  after,  the  patient  became 
perfectly  easy,  when  the  hernial  tumour  spontaneously  disappeared.  ,  A  dose  of 
castor  oil  was  given  next  morning,  and  his  recovery  was  rapid. 

Case  2.  July  \6th,  1838.  Was  called  to  see  an  apprentice  to  a  cabinet- 
maker, aged  fourteen  years;  had  been  afflicted  with  inguinal  hernia,  of  small 
size,  for  several  years;  had  worn  a  truss;  strangulated  six  hours,  when  I  first 
saw  him.  The  taxis  was  employed,  then  bleeding  ad  deliquium,  nauseating 
doses  of  ipecac,  cold  to  the  tumour,  and  the  taxis  resorted  to,  and  persevered  in 
until  the  abdomen  became  bloated  and  tender;  the  tumour  was  so  sore  that  the 
patient  could  not  bear  to  have  it  handled,  and  the  operation  appeared  the  only 
measure  left.  A  full  dose  of  morphine  was  administered,  and  I  began  to  pre- 
pare for  the  operation;  in  two  hours  he  became  entirely  easy,  and  the  tumour 
disappeared  spontaneously.     His  recovery  was  rapid. 

Case  3.  Stephen  Chandler,  aged  sixty-three.  With  an  inguinal  hernia,  of 
many  years  standing;  of  intemperate  habits.  After  lifting  a  heavy  weight  on 
the  morning  of  the  25th  of  September,  1840,  the  hernial  tumour  became  much 
enlarged,  and  he  was  unable  to  return  it;  being  from  home,  he  received  no  as- 
sistance until  evening,  when  he  sent  for  me.  I  found  him  in  excruciating  pain, 
with  vomiting,  tumid  abdomen,  and  the  hernial  tumour  tender  and  very  hard. 
Venesection  was  immediately  resorted  to,  with  cold  to  the  tumour,  nauseating 
doses  of  ipecac,  and  a  perseverance  in  the  taxis  for  two  or  three  hours,  with  no 
other  effect  than  to  aggravate  the  sufferings  of  the  patient.  He  was  anxious  for 
the  operation,  and  I  decided  to  pert^orm  it,  as  soon  as  daylight  should  appear. 
About  twelve  o'clock,  a  full  dose  of  morphine  was  administered,  and  I  returned 
home.  Next  morning,  at  an  early  hour,  I  visited  him,  in  company  with  Dr. 
Daniel  Havens  and  my  pupil,  Mr.  H.  O.  Jewett,  and  prepared  to  operate;  but 
to  our  surprise,  we  found  the  patient  in  a  quiet  sleep.  He  informed  us,  that 
about  four  hours  after  taking  the  morphine,  and  after  he  had  become  quite  easy, 
he  elevated  his  feet  against  the  wall  of  his  room,  and  that  in  a  few  minutes  the 
tumour  disappeared. 

Case  4.  Mr.  Butts,  of  Summerville,  Cayuga  Co.,  w^ho  had  been  afflicted 
with  a  very  large  Bubonocele  for  a  great  many  years,  and  who  wore  an  imper- 
fect truss,  had  the  hernia  strangulated  on  the  morning  of  the  26th  November, 
1841.  Being  unable  to  return  it,  he  sent  for  Drs.  Cook  and  Bennie,  who  used 
all  the  ordinary  methods  of  reduction,  without  effect,  for  several  hours.  I  was 
sent  for  to  perform  the  operation,  but  to  relieve  the  patient  from  the  intolerable 
agony  which  he  endured,  while  awaiting  my  arrival,  a  full  dose  of  morphine 
was  given  to  him  by  his  medical  attendants.     In  six  hours  from  the  time  of  its 


1842.]  Jlmerican  Intelligence,  515 

administration,  and  half  an  hour  before  my  arrival,  the  tumour  disappeared;  the 
patient  had  fallen  into  a  dosing  state,  and  the  hernia  had  spontaneously  re- 
turned without  any  effort  being  made.  The  medical  gentlemen  informed  me  that 
the  size  of  the  tumour  was  that  of  a  cocoa  nut:  very  hard,  and  so  tender  that 
touching  it  caused  great  agony. 

In  all  these  cases,  it  will  be  observed,  that  depletion  had  been  freely  used, 
with  nauseating  doses  of  medicines,  and  the  taxis  tried  and  persevered  in,  as 
long  as  was  prudent,  and  until  the  tenderness  was  such  that  it  could  not  be 
borne.  The  use  of  the  opium  was  accidental,  (at  least  in  two  of  the  cases,)  and 
not  given  with  a  view  to  facilitate  the  return  of  the  hernia,  but  rather  to  relieve 
the  intolerable  agony,  while  awaiting  the  arrival  of  a  surgeon.  In  every  in- 
stance, the  relief  was  soon  after  the  system  began  to  feel  the  effects  of  the  doses, 
and  before  the  perfect  relaxation  which  the  full  effect  of  opium  produces.  One 
striking  effect  was  observed  in  all  the  cases.  The  patient  ceased  bracing  his 
muscles  and  straining,  which  they  are  apt  to  do  when  labouring  under  stran- 
gulated hernia,  which  produces  tension  of  the  abdominal  muscles,  and  greatly 
hinders  the  return  of  the  protruded  bowel.  The  bleeding  and  other  relaxing 
measures,  which  preceded  the  administration  of  the  morphine,  no  doubt  had 
their  influence  in  preparing  the  system;  as  I  have  often  observed,  that  the  good 
effects  of  opium  are  much  more  happy  subsequent  to  thorough  depletion.  To- 
bacco injection,  I  have  not  myself  used  in  strangulated  hernia;  1  have  seen  it 
used,  but  I  must  say,  not  with  that  success  which  impressed  me  favourably;  it 
often  produces  unpleasant  effects;  more  often,  I  think,  than  is  generally  appre- 
hended. I  should  much  prefer  the  narcotism  of  opium  to  any  other  of  that  class 
of  remedies;  and  if  it  does  not  succeed,  the  patient  is,  from  his  calmness  and 
quietude,  admirably  prepared  for  the  operation. — New  York  Med.  Gaz.,  March 
30,  1842. 

Mcohol  detected  in  the  Brain. — The  following  case  occurred  at  the  Royal  In- 
firmary, Edinburgh,  during  the  residence  of  Dr.  Lewis  there,  as  House-Surgeon, 
and  it  is  communicated  by  him  to  the  editors  of  the  Medical  Examiner. 

June,  1840. — Waiter  Smith  aged  45,  was  brought  into  the  Infirmary  by  the 
Police,  being  in  a  state  of  coma,  and  with  a  barely  perceptible  pulse.  The 
countenance  was  pale  and  turgid;  there  was  a  frothy  fluid  discharging  from  the 
mouth,  and  the  breath  had  a  strong  alcoholic  odour.  No  injury  could  be  detected 
on  any  part  of  the  body.  An  emetic  was  given,  and  hot  applications  were  made 
to  the  extremities,  but  he  died  in  twenty  minutes  after  admission.  On  inquiry, 
it  was  ascertainlld  that  he  had  been  in  habits  of  extreme  intemperance. 

The  vessels  oi^he  surface  of  the  brain  were  found  on  dissection  to  be  more 
than  usually  filied  with  black  blood,  and  there  was  quite  an  effusion  of  serum 
under  the  arachnoid.  About  an  ounce  of  the  same  fluid  was  found  in  the  ven- 
tricles. The  posterior  part  of  the  left  lung  was  gorged  with  blood,  and  the 
bronchial  tubes  contained  a  considerable  quantity  of  a  frothy  fluid.  The  other 
parts  were  generally  healthy.  No  alcoholic  odour  could  be  detected  in  the  brain 
or  in  any  other  part  of  the  body. 

As  it  was  probable,  but  not  certain,  that  alcohol  had  been  the  cause  of  death 
in  this  case,  it  was  decided  to  ascertain,  if  possible,  the  presence  of  that  sub- 
stance by  chemical  analysis.  Dr.  Lewis,  pursuing  the  directions  of  Dr.  Percy, 
cut  about  eight  ounces  of  the  brain  into  slices,  and  then  transferred  them  into  a 
matrass,  covering  the  whole  with  a  small  quantity  of  water.  A  bent  glass  tube 
was  then  adapted  to  the  matrass,  and  the  fluid  was  distilled  over  an  Argand 
lamp.  After  a  drachm  and  a  half  of  the  liquid  was  thus  distilled,  the  operation 
was  discontinued,  and  an  adequate  quantity  of  subcarbonate  of  potash,  well 
dried,  was  introduced  into  the  tube,  which  was  then  hermetically  sealed,  and 
the  contents  well  shaken.  "The  mixture  was  allowed  to  settle,  and  after  a 
little  while,  a  stratum  of  a  very  mobile,  oily-looking  fluid  was  distinctly  ob- 
served floating  on  the  saturated  solution  of  potash,  separated,  however,  from  it, 
by  some  ash-coloured  flocculi.  In  order  to  prove  that  this  supernatant  stratum 
was  alcohol,  it  was  tested  next  morning  in  the  presence  of  Drs.  Reid  and  Low, 


516  American  Intelligence,  [Oct. 

both  by  flame  and  camphor.  It  burned  readily  with  a  blue  flame,  and  dissolved 
camphor  rapidly,  leaving  little  or  no  doubt  as  to  its  nature." 

The  supernatant  fluid  in  such  cases,  may  be  withdrawn  by  means  of  a  pipette, 
and  its  character  can  at  once  be  arrived  at,  by  blowing  into  the  pipette,  and  ap- 
plying its  extremity  to  the  flame  of  a  lamp  or  candle. 

Dr.  Lewis  claims  this  as  only  the  second  case  in  which  alcohol  has  been  de- 
tected in  the  brain  by  chemical  analysis,  Dr.  Percy  having  been  the  first  who 
proved  it.  It  is  remarkable  that  althnugh  a  sufficient  quantity  was  thus  detected  in 
the  substance  of  the  brain,  yet  in  none  of  his  experiments  vjas  Dr.  Percy  able  to 
obtain  any  from  the  fluid  of  the  ventricles. — Med.  Examiner  ^  New  Series,  May  7, 
1842. 

Leeching  in  Erysipelas. — Our  esteemed  friend,  Dr.  Geo.  Hayward  of  Boston, 
maintains  that  bleeding  by  leeches  in  erysipelas  is  both  safe  and  useful.  "  The 
leeches,"  he  observes,  "should  be  applied  on  the  sound  skin  in  the  immediate 
neighbourhood  of  the  disease;  and  when  thus  applied,  they  often  seem  to  miti- 
gate its  violence,  without  in  a  single  instance,  to  my  knowledge,  causing  any 
serious  inconvenience. 

"1  advert,"  he  adds,  'Uo  this  subject  now,  because  Mr.  Liston,  in  his  Ele- 
ments of  Surgery,  says,  'bleeding  by  leeches  is  not  admissible,  for  the  leech 
bites  prove  a  source  of  irritation,  and  are  liable  to  suppurate;  erysipelas  has 
been  often  produced  by  leeching.'  This,  to  be  sure,  is  high  authority;  at  the 
same  time  I  must  be  allowed  to  say,  that  having  used  them  freely  in  this  disease 
for  more  than  fifteen  years  without  such  effects,  I  shall  continue  the  practice 
until  something  occurs  to  convince  me  that  T  am  in  an  error.  Notwithstanding 
the  strong  terms  of  commendation  in  which  he  speaks  of  free  incisions,  it  can- 
not be  denied,  that  though  in  some  cases  they  may  be  resorted  to  without  dan- 
ger and  with  great  benefit,  they  are  not  adapted  to  all,  and  are  occasionally 
unsafe.  It  is  well  known  that  the  hemorrhage  from  them  in  some  cases  has 
been  excessive,  and  in  others  fatal;  and  there  is  no  one  probably  who  would 
employ  them  in  erysipelas  of  the  head  and  face,  where  leeches  are  often  used  to 
the  utmost  advantage.  It  is  not  denied  that  inflammation  often  follows  the 
application  of  leeches,  but  it  is  by  no  means  certain  that  it  is  of  an  erysipela- 
tous character.  It  resembles  that  which  frequently  arises  in  consequence  of  a 
blister,  and  like  it  passes  off"  spontaneously." — JVeiv  England  Quarterly  Journal 
of  Med.  and  Surg.,  July,  1842. 

Subcutaneous  Division  of  the  Masseter  Muscle. — Dr.  J.  W.  Schmidt,  of  New 
York,  records  in  the  Boston  Med.  and  Surg.  Journ.,  (July  6,  1S42,)  the  follow- 
ing example  of  this. 

Miss  S.  had  laboured  for  more  than  twelve  years  under  the  very  serious  in- 
convenience of  not  being  able  to  open  her  mouth,  owing  to  a  contraction  and 
rigidity  of  one  of  the  masseter  muscles,  which  was  caused  by  an  extensively 
ulcerated  throat  when  a  child.  The  jaw  was  not  only  so  closed  that  the  end  of 
the  little  finger  could  not  be  inserted  between  the  incisors,  but  was  also  much 
drawn  to  one  side.  Frequent  attempts  had  been  made  to  open  the  jaws  by  means 
of  an  instrument,  which  I  have  seen  succeed  in  cases  of  immobility  of  the  jaw, 
produced  from  the  use  of  mercury,  and  described  by  Professor  Mott  in  the  fifth 
volume  of  the  American  Journal  of  Medical  Sciences  for  November;  but  no  per- 
manent good  resulted  from  this  instrument,  for  after  its  use  the  contractility  of 
the  masseter  seemed  only  aggravated,  and  the  jaw  rendered  more  firmly  resistant. 

The  young  lady  being  very  desirous  to  have  this  inconvenience  and  deformity 
removed,  after  some  examination  of  the  case  I  determined  on  the  following  ope- 
ration. On  the  8th  of  October,  1841,  in  the  presence  of  my  friends  Professor 
Mott  and  Dr.  C.  A.  Porter,  I  passed  a  narrow  bistoury  through  the  mucous  mem- 
brane of  the  mouth,  immediately  in  front  of  the  anterior  edge  of  the  masseter 
muscle,  about  on  a  line  with  the  alveolar  processes  of  the  lower  jaw.  Holding 
the  integument  up  from  the  muscle  with  one  hand,  the  bistoury  was  passed  over 
the  masseter,  between  it  and  the  integuments,  and  the  muscle  completely  divided 


1842.]  American  Intelligence,  517 

to  the  bone.  The  mouth  was  immediately  opened  to  near  the  usual  size,  and 
the  lateral  distortion  of  the  jaw  much  improved.  Considerable  hemorrhage  fol- 
lowed, and  some  extravasation  into  the  cellular  substance,  which  gradually  sub- 
sided, and  the  case  succeeded  well.  To  prevent  union  of  the  muscles  as  before, 
pieces  of  soft  wood,  wedge-shaped,  were  kept  in  the  mouth  during  the  night, 
and  occasionally  during  the  day. 

Hydrated  Peroxide  of  Iron. — Our  cotemporary,  the  American  Journal  of 
Pharmacy^  for  April  last,  contains  an  interesting  article  on  this  substance,  by 
Wm.  Proctor,  Jr.,  read  at  the  Pharmaceutical  meeting  of  the  Philadelphia 
College  of  Pharmacy,  Feb.  28lh,  1842. 

The  following  are  Mr.  Proctor's  conclusions: — 

1st.  That  hydrated  peroxide  of  iron,  even  when  kept  under  water,  gradually 
decreases  in  its  power  of  neutralizing  arsenious  acid. 

2d.  That  if  kept  in  the  form  of  a  thick  magma,  it  will  retain  its  properties 
longer  than  when  mixed  with  much  water. 

3d.  That  this  decrease  in  power  is  probably  due  to  a  change  in  the  relative 
proportion  of  the  oxide,  and  the  water  chemically  combined  with  it,  as  well  as 
to  an  alteration  in  its  state  of  aggregation. 

4th.  That  from  the  experiments  of  Orfila,  and  others,  the  dry  hydrated  oxide 
possesses  the  power  to  a  considerable  extent  of  neutralizing  arsenious  acid,  and 
it  should  be  used  in  the  absence  of  the  moist  and  recent  preparation. 

5th.  That  hydrated  peroxide  of  iron  may  be  obtained  in  a  state  fit  for  use  in 
10  or  15  minutes,  by  using  a  solution  of  the  persulphate  of  iron.     And, 

Lastly.  That  the  recent  oxide  should  he  used  in  all  cases  where  it  is  attain- 
able, in  preference  to  that  long  kept. 

Oxide  of  Silver. — M.  Augustine  Duhamel,  a  very  intelligent  pharmaceutist 
of  Philadelphia,  gives  in  i\ie  American  Journal  of  Pharmacy  ^  the  following  method 
of  preparing  the  oxide  of  silver,  a  preparation  to  which  attention  has  lately  been 
drawn  in  this  journal.     See  Nos.  for  Jan.  1842,  p.  204,  and  April,  p.  464. 

"It  is  obtained  by  dissolving  silver  in  nitric  acid  and  precipitating  the  solu- 
tion by  caustic  potash  or  lime  water;  or  take, 

Crystallized  Nitrate  of  Silver,        ^j.  ' 

Caustic  Potash,  ^vij. 

Pure  Water,  Sxviij. 

"  Dissolve  the  nitrate  of  silver  in  two  or  three  ounces  of  the  water,  and  then 
separately  the  pure  potassa  in  the  remainder  of  the  water;  mix  the  two  solutions, 
stir  with  a  glass  rod,  and  throw  the  whole  upon  a  filter:  finally,  wash  the  pre- 
cipitate from  adhering  alkali,  and  dry  carefully.  The  product  will  be  seven  and 
a  half  drs.  Oxide  of  silver  is  of  a  brownish  gray  colour,  but  becomes  darker 
by  drying.  It  is  very  sparingly  soluble  in  pure  water,  and  exerts  an  alkaline 
reaction  upon  litmus  reddened  by  an  acid." 

Ligature  of  the  common  Iliac. — This  operation  has  recently  been  performed  by 
Dr.  Edward  Peace,  on  a  patient  in  the  Pennsylvania  Hospital,  labouring  under 
inguinal  aneurism  of  the  right  side.  Up  to  the  present  period,  the  28th  day,  the 
case  has  gone  on  favourably,  not  a  single  untoward  symptom  having  occurred. 
We  are  promised  a  report  of  the  operation. 

Br.  Harris'  case  of  Resection  of  the  Elbow-joint. — The  first  operation  for  resec- 
tion of  the  elbow-joint  in  this  country,  was  performed  in  June,  1835,  by  our 
friend  Dr.  Thomas  Harris,  who  published  a  full  account  of  the  case  in  our  No. 
for  Feb.  1837,  p.  341  et  seq.  This  paper  seems  to  have  been  overlooked  by  one 
of  our  cotemporaries. 

Substitute  for  a  Warm-bath. — Dr.  Hale  of  Boston,  has  several  times  tried  the 
following  method  of  bathing  for  children,  and  with  very  pleasant  effects.     An 
No.  VIII.— -October,  1842.  44 


518  Jlmerican  Intelligence,  [Oct. 

India  rubber  cloth  is  to  be  spread  upon  the  bed;  a  blanket  being  next  dipped  in 
warm  water,  the  patient  is  wrapped  in  it,  and  this  is  then  covered  with  a  warm 
dry  blanket.  This  he  says  is  accomplished  with  almost  no  fatigue  or  exposure 
to  the  patient,  and  appears  to  answer  all  the  purposes  of  a  full  bath. — N.  E. 
Quart.  Journ.,  July,  184*2. 

Immovable  .Apparatus. — Two  suits  have  recently  been  instituted;  one  in  Georgia 
and  another  in  Pennsylvania,  for  malpraxis,  in  consequence  of  gangrene  fol- 
lowing the  employment  of  the  starched  bandage,  applied  for  the  cure  of  frac- 
tures. Notwithstanding  the  weight  of  authority  in  favour  of  this  apparatus,  the 
opinions  we  have  expressed  that  its  use  was  not  free  from  danger,  is  fully  sus- 
tained by  these,  as  well  as  by  other  cases  formerly  noticed.  See  No.  for  Feb. 
1840,  p.  460. 

Connecticut  Medical  Society.  This  society  held  its  annual  convention  on  the 
11th  of  May  last,  and  elected  the  following  officers  for  the  ensuing  year: — Elijah 
Middlebrook,  M,  D.,  President,-  Luther  Ticknor,  M.D.,  Fice-Fresident,-  Virgil 
M.  Dow,  M.  D.,  Treasurer^  Archibald  Welch,  M.  D.,  Secretary.  A  dissertation 
on  uterine  irritation  was  read  by  Dr.  Chas.  Woodward,  and  a  copy  requested  to 
be  placed  on  file. 

Medical  Society  of  the  state  of  Tennessee. — The  thirteenth  annual  meeting  of 
this  society  was  held  at  Nashville,  on  the  2d  of  May,  1842.  The  following 
officers  were  elected  for  the  ensuing  year;  President^  Dr.  A.  H.  Buchanan  of 
Columbia;  Vice-President^  Dr.  Geo.  Thompson  of  Rutherford  Co.;  Treasurer^ 
Dr.  J.  Selby;  Corresponding  Secretary^  Dr.  Waters;  Recording  Secretary^  Dr.  R. 
Martin.  Several  cases  were  reported;  and  a  paper  on  the  Theory  and  Pathology 
of  Fever  was  read  by  Dr.  Buchanan,  which  is  published  with  the  transactions 
of  the  society.  A  committee  was  appointed  to  obtain  a  suitable  piece  of  plate, 
to  be  presented  to  Prof.  Yandell,  as  an  award  for  his  prize  essay  on  fever,  last 
year. 

Medical  College  of  Georgia.- — The  class  in  this  school  during  the  session  1841 
— 42,  numbered  114.  At  the  close  of  the  session,  24  received  the  degree 
ofM.D. 

Kemper  College. — The  degree  of  M.D.  was  conferred  on  the  1st  of  March 
last,  on  13  of  the  class. 

Ruschenhergerh  Natural  History. — The  fourth  book  of  this  useful  work,  treat- 
ing of  Reptiles  and  Fishes,  has  been  recently  published  by  Messrs.  Turner  & 
Fisher. 

Expulsion. — Dr.  John  Starkweather,  of  Upton,  W^orcester  Co.,  Mass.,  has  been 
expelled  from  the  Massachusetts  Medical  Society,  for  publicly  advertising  for 
sale  a  medicine,  the  composition  of  which  he  keeps  secret,  and  also  offering  to 
cure  diseases  by  the  same  medicine. — Med.  Com.  Mass.  Med.  Soc,  1842. 


INDEX. 


Abscess  of  the  lungs,  recovery  from,  174. 

Adelmann,  statistics  of  menstruation,  213. 

Air  in  veins,  184. 

Alcohol  detected  in  the  brain,  515. 

Alessi,  hereditary  ptosis,  482. 

Amaurosis,  intermittent,  481. 

Amputation  in  spreading  gangrene,  182. 

of  lower  jaw,  277. 

— — during  pregnancy,  192. 

— — —  for  diseased  bone  in  children, 

186. 

Amussat's  operation  for  artificial  anus  in 
infant  with  imperforate  rectum,  181. 

Andral   on  the  physical  alterations  of  the 
blood,  151,  432. 

Aneurism  of  femoral  artery,  332. 

,  wounds  of  femoral  vein  in  ope- 
rations for,  187. 

femoral,  51: 


Animal  magnetism,  228. 

■  substances,  composition  of,  504. 

heat,  influence    of   cerebro-spinal 

axis  in  production  of,  443. 
Aorta,  obliteration  of,  173. 
Apoplexy  and  hemiplegia,  452. 

— — ,  from  venereal  excesses,  178. 

Arm-pit,  wound  in,  ligature  of  subclavian 

and  innominata,  477. 
Arnold  on  black  vomit,  316. 
Arsenic,  detection  of,  218. 
.  recovery  after  taking  two  drachms 

of,  228. 
,  detection  of   minute  portions  of, 

487. 
,  action  of  hydrated  peroxide  of  iron 

on,  489. 
— — —  and  opium,  poisoning  with,  494. 
Artificial    anus,    for   imperforate   rectum, 


181. 


for  relief  of  intestinal  ob- 


struction, 181. 
Artificial  pupil,  248,  371. 
Asphyxia  from  plug  in  fauces,  222. 
,  the  relative  importance  of  heat 

and  cold  to  the  surface,  176. 
Azotized  principles  of  plants,  501. 

B 

Bailey,  expulsion  of  fcetus  with  membranes 
entire,  236. 

Barlow,  disease  of  the  kidneys,  457. 

Baron,  spontaneous  gangrene  of  the  cervix 
uteri,  485. 

Barral,  nicotine  from  tobacco,  222. 

Bavarian  schools  of  medicine  suspended, 
233. 

Beck,  signs  of  live  and  still  birth,  243. 

Becquerel,  tracheotomy  in  croup,  478. 

— and  Breschet,  effects  of  imperme- 
able covering  to  the  skin,  445. 


Bell,  management  of  placenta,  212. 

on  regimen  and  longevity,  145. 

on  opium  in  strangulated  hernia,  179. 

Belladonna  in  epilepsy,  456. 

as  a  douche  in  some  forms  of 

ophthalmia,  483. 
Bellingham,  rupture  of  urethra,  467. 
Benzoic  acid  in  urinary  diseases,  470,  471. 
Berard's  method  of  applving  Vienna  caustiC; 

187. 
Bicetre,  Vaudeville  enacted  in,  505. 
Biggs,  four  children  at  a  birth,  485. 
Birth,  extraordinary,  213. 

,  four  children  at  a,  485. 

Bischoff,  mode  of  distinguishing  arsenical 

from  antimonial  spots,  221. 
Black  vomit,  316. 
Bladder,  tumours  in,  mistaken  for  calculi, 

475. 
Blepharoplastic    operation    for    ectropion, 

258. 
Blood-globules,  444. 

— ,  quantity  in  cranium,  455. 

— ,  physical  alterations  of,  151,  432. 

in  brains  of  animals  bled  to  death, 

456. 
Bloody  urine,  493. 
Bolton  on  strabismus,  441. 
Bones,  colouring  of,  with  madder,  445. 
Bonjean  on  ergot,  222,  451. 
Bouchardat's  emmenagogue  solution,  447. 

croton  oil  plaster,  449. 

,  composition   of  animal  sub- 


stance, 504. 


analysis  of  menstrual  fluid, 


504. 

Bougies  of  parchment,  185. 

Brain  and  spinal  marrow,  diseases  of,  57. 

,  considerable  loss  of — cure,  477. 

— — ,  advanced  stage  of  putrefaction  of, 
226. 

,  alcohol  detected  in,  515. 

Brett,  detection  of  minute  portions  of  ar- 
senic, 487. 

Bricheteau,  oedema  of  glottis,  172. 

Brierre,  statistics  of  menstruation,  213. 

Briquet,  statistics  of  phthisis,  465. 

Brugnoli,  influence  of  cerebro-spinal  axis 
on  production  of  animal  heat,  443. 

Budd,  presence  of  lead  in  solids  and  fluids, 
221. 

Bulley,  belladonna  as  a  douche  in  some 
forms  of  oplithalmia,  483. 

Burdach,  styptic  effects  of  creasote,  166. 

Burns,  deformity  from,  66. 

Busk  on  pai-asitical  growths,  160. 

Byron,  melanosis  of  eye,  206. 


Calcis,  necrosis  of,  185. 
Calculi,  urinary,  solution  of,  193. 


520 


INDEX. 


Cancer  of  womb,  incipient  stage  of,  171. 
Cancers,  superficial,  474. 
Carr  on  crepitant  rhonchus,  360. 
Carresi,  signs  of  death  by  lightning,  485. 
Caspar,  wound  through  sternum  and  aorta, 

182. 
Castella,  varicose  crural  vein,  184. 
Cataract,  with  imperfect  development   of 

eyes,  205. 
— — — — ,  restoration  of  sight  after  loss  in 

one  eye,  by  operating  on  other,  206. 

suddenly  formed,  211. 

Catarrh,  suffocative,  176. 

Catechu,  tincture  of,  in  fissure  of  the  nipple, 

173. 
Catharine  Hospital  of  Stuttgart,  medical 

statistics  of,  368. 
Catlett  on  ergot,  450. 

Cerebro-spinal  axis,  its  influence  in  pro- 
duction of  animal  heat,  443. 
Chapman,  biography  of,  240. 
Chevalier,  poisoning  with  liquor  of  indigo- 
blue,  487. 
Child,  birth  of  living,  on  the   179th  day, 

227. 
,  born  at  the  end  of  fifth  month,  lived 

six  days,  227. 
Children,  desertion  of  in  France,  233. 
Chomel's  croton  oil  plaster,  449. 
Christison,  action  of  water  on  lead,  493. 
Cimicifuga,  in  Phthisis,  281. 
Cless's  statistics,  Catharine  Hospital,  368. 
Climate  U.  S.,  Forry  on,  110. 
Cochrane,  viable  child  bora  at  the  end  of 

fifth  month,  227. 
Cold    liquids,    consequences    of    drinking 

when  heated,  217. 
College  of  Physicians,  transactions  of,  148, 

410. 
Common  iliac,  ligature  of,  517. 
Connecticut  Medical  Society,  518. 
Cooper,  fracture  of  neck  of  femur,  187. 
on  opium  in   strangulated  hernia, 

179. 
Copper,  detection  of,  491. 
Cornea,  affliction  of,  in  nurses,  481. 
Corueitis,  turpentine  in  scrofulous,  205. 
Corpora  lutea,  495. 
Corrosive  sublimate,  antidote  to,  496. 
Cough  from  spinal  irritation,  176. 
Cow-pox  and  small-pox,  identity  of,  169. 
Cranium,  fracture  of,  with  loss  of  brain, 

477. 

— ,  quantity  of  blood  in,  455. 

Creasote  in  diseases  of  the  eye,  362. 

■ ,  styptic  effects  of,  166. 

Crepitant  rhonchus,  cause  of,  360. 

Crisp,  on  blood  in  brains  of  animals  bled  to 

death,  456. 
Croton  oil,  external  application  of,  449. 
Crural  vein,  varicose,  184 
Cysticerus  under  conjunctiva,  211. 

D 

Davis  on  opium  in  strangulated  hernia,  179. 
Davidson  on  corpora  lutea,  495. 
Debreyne  on  belladonna  in  epilepsy,  456. 
Deraeaux,  case  of  priapism,  186. 
Dendy,  sympathetic  pruritus,  174. 


Dentition  of  children,  164. 

Digitalis,  poisoning  of  camels  with,  491. 

Diospyros  Virginiana,  297. 

Dislocation  of  lower  jaw,  470. 

Dislocations,  statistics  of,  480. 

Dodd,  amputation  in  spreading  gangrene, 
182. 

Donne  on  blood-globules,  444. 

Donovan,  dislocation  of  lower  jaw  reduced 
after  ninety-eight  days,  470. 

Douglas,  tumours  in  bladder  mistaken  for 
calculi,  475. 

Doyere,  revivification  of  microscopic  ani- 
mals, 505. 

Druitt's  surgery,  439. 

Duke  of  Orleans,  post-mortem,  472. 

Dumas,  double  uterus,  447,  495. 

Dumeril,  mode  of  preserving  nitrate  of 
silver,  449. 

Dysuria,  chronic,  benzoic  acid  and  copaiba 
for,  470. 


Ecchymosis  from  injury  simulating  lacera- 
tion of  artery,  465. 

spontaneous,  resembling  exter- 


nal injury,  486. 

Ectropium,  blepharoplastic  operation  for, 
258. 

Edinburgh,  University  of,  507. 

Eighth  pair  of  nerves,  arrangement  of,  158. 

Emmenagogue  solution,  447. 

Entropium,  operation  for,  481. 

Epilepsv,  belladonna  in,  456. 

Ergot,  222,  449,  450,  451,  492. 

Evert,  minute  quantity  of  opium  destructive 
to  child,  223. 

External  iliac  artery,  ligature  of,  250. 

Extra-uterine  pregnancy,  211. 

Eyes,  melanosis  of,  206. 

»,  Lawrence  on  diseases  of,  441. 

■— ,  imperfect  development  of,  with  cata- 
ract, 205. 


Face,  gunshot  wound  of,  80, 

,  paralysis  of,  322. 

Fanterra,  reunion  of  fingers,  184. 
Feigned  diseases,  493. 
Femoral  artery,  aneurism  of,  332,  511. 
Femur,  fracture  of  neck  of,  187. 

,  spontaneous  fracture  of,  469,  470. 


Ferguson,  closure  of  jaws  cured  by  division 
of  masseter  muscle,  180. 

Ferrall  on  certain  structures  in  the  orbit, 
197. 

Fife,  ergot  of  rye,  449. 

Fingers,  reunion  of,  184. 

Flint's,  Druitt's  Surgery,  439. 

Flour  containing  lead,  225. 

Fcetal  cord,  number  of  i)ulsations  of,  212. 

Fcetus,  typhoid  fever  in,  173. 

,  expulsion  of,  with  membrane  entire, 

236,  237. 

Forry  on  climate  of  the  United  States,  re- 
view of,  110. 

,  intermittent  fever  of  New  England, 

239. 

Fracture,  ununited,  510. 


INDEX. 


521 


Fracture  of  patella,  512. 
Fractures,  deformities  after,  305. 
France,  irideremia,  205. 

,  desertion  of  children  in,  233. 

French  medical  works,  new,  508. 
Frost,  expulsion  of  a  mass   of  hair  from 
uterus,  235. 


Gangrene,  spreading,  amputation  in,  182. 

Garrod  and  Marshall  on  saliva,  158. 

Gases,  morbid  secretion  of,  402. 

Gauthier,  vaccination  in  France,  170. 

Geoghegan,  rare  form  of  internal  strangu- 
lation, 196. 

Georgia,  medical  college  of,  518. 

Gerdy,  transposition  of  viscera,  447. 

Gerhard  on  diseases  of  the  chest,  review 
of,  135. 

Gestation,  protracted,  491. 

Gibbes  on  typhoid  pneumonia,  281. 

Gibson,  complete  anchylosis  of  knee-joint, 
39. 

,  amputation  of  lower  jaw,  277. 

Glottis,  oedema  of,  172. 

Gnoli,  small-pox  in  a  child  before  birth, 
485. 

Godemer,  air  in  veins,  184. 

Godsir  on  ultimate  secreting  structure,  155. 

' ,  structure  of  kidney  and  changes  in 

granular  degeneration,  156. 

Graves,  abscess  of  lungs,  174. 

Grembler,  semi-amputation  of  uterus,  184. 

Gross's  Liston,  441. 

Guerard,  drinking  cold  liquids  when  heated, 
217. 

Guibert,  action  of  hydrated  peroxide  of 
iron  on  arsenic,  489. 

H 

Hadwen,  wounds  of  femoral  vein  in  opera- 
tions for  aneurism,  187. 

Hale,  substitute  for  warm  bath,  517. 

Hall  on  apoplexy  and  hemiplegia,  452. 

on  laryngismus  stridulus,  459. 

Hamburg,  destruction  of  medical  library 
at,  505. 

Handyside,  asphyxia,  222. 

Hare-lip,  188. 

Harris's  case  of  excision  of  elbow-ioint, 
517.  -^ 

Hartford  Retreat,  18th  annual  report,  407. 

Hays,  operation  for  artificial  pupil,  371. 

Hayward,  immovable  apparatus,  512. 

,  fracture  of  patella,  512. 

,  enlargement  of  bursa  over  pa- 
tella, 513. 

,  leeches  in  erysipelas,  516. 

Hemiplegia,  452. 

Hemorrhoids,  treatment  of,  358. 

Henkel's  improved  tourniquet,  373. 

Hernia,  strangulated,  opium  in,  179. 

,  ventral,  185. 

of  tlie  stomach,  195. 

Hildreth,  cimicifuga  and  iodine  in  phthisis, 
281. 

on  creasote  in  diseases  of  the  eye, 

362. 

Hiriart,  belladonna  in  sciatica,  170. 


Hocken  on  amaurosis,  440. 

on  hysteria,  440. 

Hoering,  cysticerus  under  conjunctiva,  211. 
Hoist,  influence  of  new  penitentiary  system 

on  health  of  prisoners,  405. 
Homoeopathy,  505. 
Hope  on  the  heart,  430. 
Horner,  aneurism  of  femoral  artery,  332. 

,  treatment  of  hemorrhoids,  358. 

Houston  on  hare-lip,  1 88. 

ecchyniosis  from  injury  simulating 


laceration  of  an  ai-tery,  465. 

Hughes,  statistics  of  phthisis,  464. 

Humerus,  ununited  fracture  of,  cured  by 
seton,  475. 

Hulin,  wound  in  arm-pit,  ligature  of  sub- 
clavian and  innominata,  477. 

Hyde,  rupture  of  uterus,  249. 

I 

Immovable  apparatus,  512,  518. 
Indigo-blue  liquor,  poisoning  with,  487. 
Insane  Hospital,  reports  of,  notices  of,  136. 
Insanity,   Leuret   on  moral    treatment  of, 

375. 
Iodine   injections  in    treatment  of   serous 

cysts,  180. 
Intermittent  fever  of  New  England,  239. 
Intestinal   obstruction,    artificial  anus   for, 

181. 
Irideremia,  205. 
Iron,  preparations  of,  448. 
,  hydrated  peroxide  of,  its  action  on 

arsenic,  489. 

,  mode  of  pre- 


serving, 517. 


Jacobs,  operation  for  entropion,  481. 
Jacquet,  caries  and  excision  of  ribs,  473. 
Jolly  on  quantity  of  blood  in  cranium,  455. 
Joslin  on  paralysis  of  the  face,  322. 

K 

Kane  on  Kiesteine,  13. 

on  urea  in  ascitic  fluid,  459. 

Kemper  College,  518. 

Kidney,  structure  of,  and  changes  in  granu- 
lar degeneration,  156. 
Kidneys,  disease  of,  457. 
Kiesteine,  experiments  on,  13,  222. 
King  on  toothache,  478. 
Knee-joint,  complete  anchylosis  of,  39. 


Lados,  spontaneous  ecchymosis  resembling 
external  injury,  486. 

Larrey,  obituary  notice  of,  507. 

Lassaigne,  poisoning  with  arsenic  and  opi- 
um, 494. 

Lasalle,  rupture  of  spine  by  muscular  effort, 
181. 

Laryngismus  stridulus,  167,  459,  462. 

Laudanum,  poisoning  with,  148. 

Lawrence  on  the  diseases  of  the  eye,  441. 

Lead,  poisoning  with,  225. 

,  presence  of  in  solids  and  fluids,  221. 

,  action  of  water  on,  493. 

Leroy,  vesico-vaginal  fistula,  195. 


522 


INDEX. 


Letheby  on  kiesteine,  223. 

Leuret  on  insanity,  375. 

Lewis,  pregnancy  without  usual  signs,  par- 
turition without  pains,  216. 

Liebig's  report  on  organic  chemistry,  496. 

,  azotized  principles  of  plants,  501. 

Light,  influence  on  sraall-pox  pustule,  459. 

Lightning,  death  from,  485. 

Lime  moxa,  166. 

Lisfranc,  superficial  cancers,  474. 

,  cauterization  of  neck  of  uterus, 

195. 

Liston's  Elements  of  Surgery,  441. 

Litliotomy,  328. 

London,  health  of,  506. 

schools,  507. 

Longet,  influence  of  nerves  on  muscular 
irritability,  444. 

— pneumogastric  nerves 

on  movements  of  stomach,  444. 

Loyet  on  spots  in  glass  resembling  those  of 
Marsh  produced  by  a  reducing  flame,  218. 

,  vegetables  produced  in  soils  contain- 
ing metallic  poisons,  219. 

Lunatic  asylum,  Vaudeville  enacted  in,  505. 

Lungs,  abscess  of,  174. 

M 

Madder,  colouring  of  bones  with,  445. 

Maissoneuve,  dislocation  of  sternum,  187. 

Malgaigne  on  dislocations,  480. 

Mallespine,  necrosis  of  os  calcis,  185. 

Mania,  connection  of  with  precipitate  la- 
bour, 495. 

,  decayed  teeth,  509. 

Manzini,  typhoid  fever  in  foetus,  173. 

Martin,  cataract  suddenly  formed,  211. 

Massachusetts  medical  society,  444. 

Masseter  muscle,  division  for  closure  of 
jaws,  180. 

Maturity,  signs  of,  in  new-born  children, 
489. 

Maxillary  bone,  excision  of  lower,  509. 

Mawroury  and  Thore,  ununited  fracture 
cured  by  seton,  475. 

McNaughton,  diseases  of  the  brain  and 
spinal  marrow,  57. 

Medical  society  state  of  N.  York,  transac- 
tions of,  149. 

Massachusetts,    medical 

communications,  440. 

■  colleges  U.  S,,  statistics  of,  237. 

'  advertising,  259. 

schools  of  the  west,  259. 


counsel,  shall  it  be  allowed  to  an 

accused  person,  490. 

—  men,  honours  to,  507. 


Medico-legal  dissections,  must  medical  men 
make  them  when  called  on  by  coroner, 
224. 

Meigs,  puerperal  fever,  399. 

Meillet,  sulpho-cyanuret  of  potassium,  166. 

Melanosis  of  eye,  206. 

Mendenhall,  mania  from  decayed  teeth,  509. 

Menstrual  fluid,  analysis  of,  504. 

Menstruation,  statistics  of,  213. 

Mettauer  on  malformation  of  penis  and 
male  urethra,  43. 

— — on  persimmon  in  dysentery,  297. 


Microscopic  animalcules,  revivification  of, 

505. 
Mialhe,  antidote   to   corrosive    sublimate, 

496. 
Millet,  advanced   stage   of  putrefaction  of 

brain,  without  corresponding  appearances 

of  body, 226. 
Monstrosity,  158. 

Montgomery,  cancer  of  uterus,  171. 
Morris's  case  of  poisoning  with  laudanum, 

148. 
Moyle,  polypus  of  uterus  expelled  by  ergot, 

214. 
Muhry,  identity  of  cow-pox  and  small-pox, 

169. 
Muscular  irritability,   influence   of  nerves 

on,  444. 
Mussey,  excision  of  tumour  of  neck,  253. 
,  excision  of  lower  maxillary  bone, 

509. 
Mutter,  deformity  from  burns,  66. 
Muynch,  on  influence  of  venereal  excesses 

in  production  of  apoplexy,  179. 

N 
Naranovitch,  fracture  of  femur  by  muscular 

contraction,  470. 
Nasmyth  on  the  teeth,  442. 
Nasse,  afi'ection  of  the  cornea   in  nurses, 

481. 
Navy,  assistant  surgeons  in,  259. 
Neck,  excision  of  tumour  of,  253. 
Necrosis  of  os  calcis,  185. 
Neill,  spontaneous  rupture  of  spleen,  369. 
Neuralgia,  Valleix  on,  95. 
Nicotine  in  tobacco,  222. 
Nipple,  fissure  of,  173. 
Nitrate  of  silver,  mode  of  preserving,  449. 
Nitric  acid,  new  test,  224. 
Norris  on  deformities  after  fractures,  305. 
Nott  on  lithotomy,  328. 
Nursing  women,  sore  mouth  and  diarrhoea 

of,  300. 

O 

Opium  in  strangulated  hernia,  179,  514. 

■,    minute    quantity,    destructive    to 


child,  223. 

-,  varieties  of,  in  symptoms  of  poison- 


ing with,  225. 

smoking  in  china,  229. 


Optic  nerve,  rupture  of,  482. 
Orbit,  certain  structures  in,  197. 
-,  wound  of,  482. 


Obituary  record,  233. 

Orfila,  absorption  of  mineral  poisons,  494. 

Organic   chemistry  applied  to   physiology 

and  pathology,  496. 
Osborne,  lime  moxa,  166. 
OsteO'Sarcoma  of  lower  jaw,  277. 


Pancoast,  plastic  operations,  337. 

,  Quain's  anatomical  plates,  440. 

Pancreas,  extensive  disease  of,  178. 
Parasitical  growths  on  living  animals,  160. 
Paris,  health  of,  506. 

,  medical  faculty  of,  507. 

Patella,  fracture  of,  512. 


INDEX. 


523 


Patella,  enlargement  of  bursa  over,  513. 

Peace,  ligature  of  conamon  iliac,  517. 

,  ligature  of  external  iliac  artery,  250. 

Peebles,  gunshot  wound  of  face,  80. 

Pelouse,  solution  of  urinary  calculi,  193. 

Penis,  extravasation  of  blood  into  subcu- 
taneous cellular  tissue,  85. 

Penis,  malformations  of,  43. 

Penitentiary  systems,  influence  of,  on  health 
of  prisoners,  405,  410. 

Pennock's  edition  of  Hope  on  the  Heart, 
430. 

Peracchi,  abstraction  of  uterus  after  de- 
livery, 214. 

Petrequin,  operation  for  symblepharon, 
203. 

,  statistics  of  menstruation,  213. 

Pharmacopceia  U.  S.  143. 

Phillips,  wound  of  the  orbit,  482. 

Phthisis,  cimicifuga  and  iodine  in,  281. 

— ,  statistics  of,  464,  465. 

Placenta,  management  of,  212. 

Plants,  azotized  principles  of,  501. 

Plea,  quick  with  child,  220. 

Pleasants  on  condition  of  the  profession  in 
Brazil,  88. 

Pneumothorax,  458. 

Poisoning,  487,489,  491,494. 

Poisons,  absorption  of  mineral,  494. 

Polypi  of  rectum,  188. 

Polypus,  fold  of  Schneiderian  membrane 
mistaken  for,  185. 

of  uterus  expelled  by  ergot,  214. 

Post,  blepharoplastic  operation,  258. 

Potassium  sulpho-cyanuret,  166. 

Power,  femoral  aneurism,  511. 

Precipitate  labour,  connection  of,  with 
mania,  495. 

Pregnancy  unattended  with  the  usual  signs, 
parturition  without  pain,  216. 

— — —  amputation  during,  192. 

signs  of,  13,  223. 

,  extra  uterine,  211. 

Priapism,  spontaneous,  186. 

Proctor  on  hydrated  peroxide  of  iron,  517. 

Pruritus,  sympathetic,  174. 

Ptosis,  hereditary,  482. 

Puccinotti,  signs  of  death  by  lightning,  485. 

Puchelt,  double  pneumothorax,  458. 

Puerperal  fever,  399. 

Pulsations  of  foetal  cord,  212. 


Quain's  Anatomical  Plates,  440. 

Quekett  on  ergot,  222. 

Quick  with  child,  plea  of,  220.  ^ 

R 

Rectum,  polypi  of,  188. 

Registrar  general's  report,  418. 

Reiter,  identity  of  cow-pox  and  small-pox, 

169. 
Renauldin,  superfcetation,  220. 
Rhinoplastic  operations,  337. 
Ribs,  caries  and  excision  of,  473. 
Richter,  rupture  of  uterus,  212. 
Rigby's  Midwifery,  review  of,  123. 
Roberts  on  thymic  enlargement,  245. 
Robinson,  suffocative  catarrh,  176. 


Rodgers,  artificial  pupil  and  subsequent 
section  of  rectus  superior,  248. 

Rodenstab's  case  of  monstrosity,  158. 

Roemer,  obliteration  of  aorta,  173. 

Roesch,  nature  and  treatment  of  scrofula, 
457. 

Rupture  of  uterus  during  gestation,  212. 

Ruschenberger's  Natural  History,  518. 

Ryland  on  laryngismus  stridulus,  462. 


Saliva,  experiments  on,  158. 

Sanguinaria  canadensis  as  a  cure  for  gela- 
tinous polypus,  368. 

Schillbach,  poisoning  with  flour  containing 
lead,  225. 

Schlesier,  ulcers  between  toes,  182. 

Schnackenberg,  extraordinary  birth,  213. 

Schneiderian  membrane,  fold  of,  mistaken 
for  polypus,  185. 

Sciatica,  extract  of  belladonna  for,  170. 

Sclerotica,  rupture  of,  201. 

Scriveners'  spasm,  476. 

Scrofula,  nature  and  treatment  of,  457. 

Secale  cornutum,  see  ergot. 

Secreting  structure,  ultimate,  155. 

Semple,  instant  death  from  wound  of  stom- 
ach, 487. 

Serre,  failure  of  operation  for  cataract  in 
one  eye,  sight  restored  in  both  by  opera- 
tion on  other,  206. 

Serres  and  Doyere  on  coloration  of  bones 
by  madder,  445. 

,  influence  of  light  on  small-pox  pus- 


tule, 459. 

Seton,  ununited  fracture  cured  by,  475. 
Shanks  on  sore  mouth  of  nursing  women, 

300. 

case  of  gelatinous  polypus,  368. 

Shipman,  opium  in  sti'angulated  hernia,  514. 
Siemens,  morbid  secretion  of  gases,  402. 
Skae,  varieties  in  symptoms  of  poisoning 

with  opium,  225. 
Skin,  effects  of  impermeable  covering  to, 

445. 
Small-pox  pustule,  influence  of  light  on, 

459. 

in  a  child  before  birth,  485. 


Smith,  opium  smoking  in  China,  229. 

Snake  bites,  258. 

Snow  on  relative  importance  of  warmth 

and  cold  in  asphyxia,  176. 
Soden,  benzoic  acid  in  urinary  disorders, 

471. 
Spencer,  eighth  pair  nerves,  158. 
Spinal  irritation,  cough  from,  176. 
,  hiccup  from,  ib. 


Spine,  rupture  of  by  muscular  effort,  181. 
Spleen,  enlargement  of,  367. 

,  spontaneous  rupture  of,  369. 


Sternum,  wound  of,  182. 
,  dislocation  of,  187. 


Stoeber,  intermittent  amaurosis,  481. 
Stoltz,  polypi  of  i-ectum,  188. 
Stomach,  hernia  of,  195. 

nfluence  of  pneumo-gastric  nerve 


on  movements  of,  444. 

instant    death   from  wound   of. 


487. 


524- 


INDEX. 


Storer,  inversion  of  uterus,  247. 
Strabismus,  Bolton  on,  441. 
Strangulation,  internal,  196. 
Streeter,  pulsations  of  fcetal  cord,  212. 
Stromeyer,  scriveners'  spasm,  476. 
Strychnine  in  paralysis  of  the  face,  322. 
Subclavian    and    innominata,  ligature    of, 

477. 
Suicide,  unsuccessful  attempt  at,  486. 
Sulphuric  acid,  poisoning  with,  489. 
Superfcetation,  220,  495. 
Sutton,  inversion  of  uterus,  83. 
Symblepharon,  203. 


Tait,  birth  of  living  child  on  179th  day, 
227. 

Tavignot  on  amputation  for  diseased  bone, 
186. 

Taylor,  signs  of  maturity  in  new-born  chil- 
dren, 489. 

Teale,  artificial  anus,  181. 

Teeth,  Nasmyth  on,  442. 

,  mania  from  decayed,  509. 

Tennessee  Medical  Society,  518. 

Terme  and  Montfalcon,  desertion  of  chil- 
dren in  France,  233. 

Thigh-bone,  spontaneous  fracture  of,  469, 
470. 

Thymic  asthma,  167. 

Thymus  gland  enlarged,  169. 

ToiDacco,  nicotine  in,  222. 

Toes,  ulcers  between,  182. 

Toogood,  crowing  inspiration,  167. 

,  recovery  after  taking  two  drachms 

of  arsenic,  228. 

,    spontaneous  fracture   of  femur, 

469. 

Toothache,  478. 

Tourniquet,  improvement  in,  373. 

Tracheotomy  in  croup,  478. 

Transposition  of  viscera,  447. 

Tripler,  ununited  fracture,  510. 

Trousseau  on  dentition  of  children,  164. 

Tumours  in  bladder  mistaken  for  calculi, 
475. 

developed  on  cicatrices,  476. 

Turpentine  in  scrofulous  corneitis,  205. 

Typhoid  pneumonia,  289. 

fever  in  foetus,  173. 

Tyson's  chalybeate  preparations,  448. 

U 
University  college,   London,   professor   of 

midwifery,  233. 
Urea  in  fluid  of  dropsy,  459. 


Urethra,  malformations  of,  43. 
ru[)ture  of,  467. 


Urinary  disorders,  benzoic  acid  and  copaiba 
in,  470. 

Urine,  sulphuric  acid  detected  in,  489. 

,  bloody  colour  of,  ])roduced  by  eat- 
ing certain  substances,  493. 

U.  S.  army,  surgeon  general's  report,  150. 

Uterus,  inversion  of,  83,  247. 

,  cancer  of,  171. 

,  semi-amputation  of,  184. 

,  cauterization  of  neck  of,  195. 

,  rupture  of,  212,  249. 

,  abstraction  of,  after  delivery,  214. 

expulsion  of  a  mass  of  hair  from, 


235. 


485. 


double,  447,  495. 
spontaneous  gangrene  of  neck  of, 


Vaccination  in  France,  170. 

Valleix  on  neuralgia,  review  of,  95. 

Valleix's  practitioner's  guide,  147. 

Van  Gesscher's  bougies,  185. 

Varicose  veins,  mode  of  applying  Vienna 

caustic,  187. 
Vaudeville  enacted  in  a  lunatic  asylum,  505, 
Veins,  air  in,  184. 
Velpeau  on  iodine  injections  in  serous  cysts, 

180. 
Venereal  excesses,  as  a  cause  of  apoplexy, 

178. 
Ventral  hernia,  185. 
Verdigris-  poisoning  with,  487. 
Verguin,  detection  of  copper,  491. 
Verte,  unsuccessful  attempt  at  suicide.  486. 
Vesico-vaginal  fistula,  195. 
Viscera,  transposition  of,  447. 

W 

Walker,  benzoic  acid  and  copaiba  in  uri- 
nary disorders,  470. 
Warm  bath,  substitute  for,  517. 
Water,  action  of,  on  lead,  493. 
Williams'  address,  440. 
Wilson,  disease  of  pancreas,  178. 

and  Quain's  anatomical  plates,  440. 

—  Anatomist's  Vade  Mecum,  442. 


Yellow  fever,  316. 


Zartmann,  fracture  of  cranium  with  consi- 
derable loss  of  brain,  477. 


Date  Due 


1842 
American  journal  of  v,4>-.N.S 
the  medical  sciences 


ISSUED   TO 


American  Oou.rnd\ 
liecl.   jciences 

Vol.  4--M.5. 


SMfTHSONIAN  INSTITUTION  LIBRARIES 


♦  •,   V 


^ 


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